1568982940 NPI number — GAYLE MARIE BLUM PMHNP-BC. FNP-BC

NPI Number: 1568982940
Health Care Provider/Practitioner: GAYLE MARIE BLUM PMHNP-BC. FNP-BC

NPI Number : 1568982940 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568982940",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BLUM",
    "FirstName": "GAYLE",
    "MiddleName": "MARIE",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "PMHNP-BC. FNP-BC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "15272 DOVER RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "REISTERSTOWN",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21136-3882",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "410-812-2342",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "14707 OLD HANOVER RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BORING",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21020-1000",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "410-812-2342",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/26/2017",
    "LastUpdateDate": "03/13/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "R201227",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": "R201227",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}