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NPI Code Detail

MEDICARE: LORA C BLOUNT NP-C

MEDICARE: LORA C BLOUNT NP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner0024166265VA

General Provider Information

NPI Number : 1922021815
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORA C BLOUNT NP-C
Provider Business Mailing Address
First Line : 1040 UNIVERSITY BLVD
Second Line : SUITE 200
City : PORTSMOUTH
State : VA
Zip : 23703-2650
Country : US
Telephone Number : 757-397-6930
Fax Number : 757-393-4864
Provider Business Practice Location Address
First Line : 1040 UNIVERSITY BLVD
Second Line : SUITE 200
City : PORTSMOUTH
State : VA
Zip : 23703-2650
Country : US
Telephone Number : 757-397-6930
Fax Number : 757-393-4864
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 08/02/2012

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