Provider Demographics
NPI:1962396192
Name:MAMAC-KAALEKAHI, BLAIRE (FNP-C)
Entity type:Individual
Prefix:
First Name:BLAIRE
Middle Name:
Last Name:MAMAC-KAALEKAHI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BLAIRE
Other - Middle Name:
Other - Last Name:TOKOMAATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3216 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2682
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:337 E VIRGINIA AVE UNIT B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1220
Practice Address - Country:US
Practice Address - Phone:602-424-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF05250772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily