Basic Information
| Provider Information | |||||||||
| NPI: | 1205559754 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLAIR | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | MORRIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28125 SUNNY BEACH RD | ||||||||
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| City: | GRAND RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557445883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7015274559 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1601 GOLF COURSE RD | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557448648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183263401 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2022 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 138362 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.