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General NPI Number Information
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NPI Number | 1114066701
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Entity Type | Individual
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Provider Name | LORA LEE BLASIUS MSN APNP
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Gender | Female
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | 161 WASHINGTON ST. SUITE 1400 EIGHT TOWER BRIDGE
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428
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Country | US
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Telephone | 866-825-3227
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Fax | 484-726-0013
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Provider Business Mailing Address
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Address Line | PO BOX 900
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City | WALES
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State | WI
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Zip | 53183-0900
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Country | US
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Telephone | 262-646-3341
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Fax | 262-646-8731
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2102033
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License Number State | WI
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