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General NPI Number Information
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NPI Number | 1023686185
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Entity Type | Individual
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Provider Name | LEAH MIRA BLUM APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 1918 RANDOLPH RD STE 220
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City | CHARLOTTE
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State | NC
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Zip | 28207-1109
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Country | US
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Telephone | 704-316-1125
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Fax | 704-316-1143
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Provider Business Mailing Address
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Address Line | PO BOX 60447
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City | CHARLOTTE
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State | NC
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Zip | 28260-0447
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Country | US
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Telephone | 704-316-1125
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Fax | 704-316-1143
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 0028739
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5017837
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 0028739
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 0028739
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0028739
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License Number State | OH
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