Basic Information
| Provider Information | |||||||||
| NPI: | 1134485329 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLAIR | ||||||||
| FirstName: | SUMMER | ||||||||
| MiddleName: | ALIA | ||||||||
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| Credential: | ANP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 S 3RD ST STE 210 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432154206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8334455998 | ||||||||
| FaxNumber: | 8442495579 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 LINDA ST | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | ROCKY RIVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441161853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402503560 | ||||||||
| FaxNumber: | 2167127066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2012 | ||||||||
| LastUpdateDate: | 02/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 13164 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.