Individual provider · NPI-1

Blair J Anderson

Community Health Worker · Detroit, MI

NPI number1790500874
StatusActive
Last updated in NPPESNov 22, 2024

Details

NPI
1790500874
Entity type
Individual (NPI-1)
Name
Blair J Anderson
Sex
Male
Sole proprietor
Yes
Enumeration date
Nov 22, 2024
Certification date
Nov 22, 2024
Last updated
Nov 22, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
172V00000X Community Health Worker––Yes

Practice location

861 Taylor St
Detroit, MI 48202-1723

Phone 313-915-8540

Mailing address

861 Taylor St
Detroit, MI 48202-1723

Phone 313-915-8540

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