Basic Information
| Provider Information | |||||||||
| NPI: | 1558337824 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLAIR | ||||||||
| FirstName: | IRENE | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 NEPONSET ST FL 12 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085952655 | ||||||||
| FaxNumber: | 5088540822 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 NEPONSET ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085952655 | ||||||||
| FaxNumber: | 5088540822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 09/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 144383 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 042472266002 | 01 | TRICARE | OTHER | NP3378 | 01 | BLUE SHIELD INDEMNITY | OTHER | NP3378 | 01 | MEDICARE B | OTHER | 57181 | 01 | FALLON COMM HEALTH PLAN | OTHER | NP3378 | 01 | BLUE SHIELD HMO BLUE | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | 042472266002 | 01 | CHAMPUS | OTHER | AA459 | 01 | HARVARD PILGRIM HLTHCARE | OTHER | NP3378 | 01 | BLUE CARE ELECT | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYST | OTHER | 381321 | 01 | MVP HEALTH CARE | OTHER | 8301269 | 01 | EVERCARE | OTHER |