1114066701 NPI number — MS. LORA LEE BLASIUS MSN APNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114066701 NPI number — MS. LORA LEE BLASIUS MSN APNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLASIUS
Provider First Name:
LORA
Provider Middle Name:
LEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSN APNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRODZELLER
Provider Other First Name:
LORA
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
APNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114066701
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 900
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALES
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53183-0900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-646-3341
Provider Business Mailing Address Fax Number:
262-646-8731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 WASHINGTON ST. SUITE 1400
Provider Second Line Business Practice Location Address:
EIGHT TOWER BRIDGE
Provider Business Practice Location Address City Name:
CONSHOHOCKEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-825-3227
Provider Business Practice Location Address Fax Number:
484-726-0013
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  2102033 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1114066701 . This is a "NPI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 36027800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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