Provider Demographics
NPI:1679165823
Name:NEIN, BLAIR WILLIAMS (NP)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:WILLIAMS
Last Name:NEIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SIDNEY
Other - Middle Name:BLAIR
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:280 W EUCLID BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:VA
Mailing Address - Zip Code:23181-9378
Mailing Address - Country:US
Mailing Address - Phone:804-815-9918
Mailing Address - Fax:
Practice Address - Street 1:6609 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-5194
Practice Address - Country:US
Practice Address - Phone:804-824-9153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179957207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine