Provider Demographics
NPI:1184916892
Name:EATON, LORI BLANCHARD (NP-C)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:BLANCHARD
Last Name:EATON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8821 BLAKENEY PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6594
Mailing Address - Country:US
Mailing Address - Phone:704-887-1101
Mailing Address - Fax:704-887-1102
Practice Address - Street 1:8821 BLAKENEY PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6594
Practice Address - Country:US
Practice Address - Phone:704-887-1101
Practice Address - Fax:704-887-1102
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005165363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004981Medicaid
NC7004981Medicaid