Provider Demographics
NPI:1922021815
Name:BLOUNT, LORA C (NP-C)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:C
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:C
Other - Last Name:HARPOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1040 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-2650
Mailing Address - Country:US
Mailing Address - Phone:757-397-6930
Mailing Address - Fax:757-393-4864
Practice Address - Street 1:1040 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-2650
Practice Address - Country:US
Practice Address - Phone:757-397-6930
Practice Address - Fax:757-393-4864
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166265363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA014717O04Medicare PIN
VAQ39852Medicare UPIN
VAVV4286AMedicare PIN
VAP01049440Medicare PIN
VA007776046Medicare ID - Type Unspecified