Individual
MARY JANE BLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 315-6430
Mailing address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 315-6430
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
076046
IA
163WC0400X
Case Management Registered Nurse
076046
IA
163WP0808X
Psychiatric/Mental Health Registered Nurse
076046
IA
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
076046
IA
Other
Enumeration date
09/11/2014
Last updated
09/11/2014
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