Healthcare Provider Details

I. General information

NPI: 1144020454
Provider Name (Legal Business Name): EMERALD BLUM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14707 OLD HANOVER ROAD
BORING MD
21020
US

IV. Provider business mailing address

14707 OLD HANOVER RD
BORING MD
21020-1000
US

V. Phone/Fax

Practice location:
  • Phone: 410-456-0122
  • Fax:
Mailing address:
  • Phone: 410-456-0122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR251394
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: