Healthcare Provider Details

I. General information

NPI: 1568982940
Provider Name (Legal Business Name): GAYLE MARIE BLUM PMHNP-BC. FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14707 OLD HANOVER RD
BORING MD
21020-1000
US

IV. Provider business mailing address

15272 DOVER RD
REISTERSTOWN MD
21136-3882
US

V. Phone/Fax

Practice location:
  • Phone: 410-812-2342
  • Fax:
Mailing address:
  • Phone: 410-812-2342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR201227
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR201227
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: