Provider Demographics
NPI:1114066701
Name:BLASIUS, LORA LEE (MSN APNP)
Entity Type:Individual
Prefix:MS
First Name:LORA
Middle Name:LEE
Last Name:BLASIUS
Suffix:
Gender:F
Credentials:MSN APNP
Other - Prefix:MS
Other - First Name:LORA
Other - Middle Name:L
Other - Last Name:BRODZELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:WALES
Mailing Address - State:WI
Mailing Address - Zip Code:53183-0900
Mailing Address - Country:US
Mailing Address - Phone:262-646-3341
Mailing Address - Fax:262-646-8731
Practice Address - Street 1:161 WASHINGTON ST. SUITE 1400
Practice Address - Street 2:EIGHT TOWER BRIDGE
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428
Practice Address - Country:US
Practice Address - Phone:866-825-3227
Practice Address - Fax:484-726-0013
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2102033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1114066701OtherNPI
WI36027800Medicaid
WI36027800Medicaid