Provider Demographics
NPI:1942678198
Name:BLAIR, DEANNA (CNM)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:FARMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 WASHINGTON ST W
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-2344
Mailing Address - Country:US
Mailing Address - Phone:304-345-4525
Mailing Address - Fax:304-345-4527
Practice Address - Street 1:108 WASHINGTON ST W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2344
Practice Address - Country:US
Practice Address - Phone:304-345-4525
Practice Address - Fax:304-345-4527
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN52285-MIDWIFE367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife