Provider Demographics
NPI:1255397220
Name:BLAKE, LORI ANN (RN, BC, FNP)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:BLAKE
Suffix:
Gender:F
Credentials:RN, BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4C NORTH AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2333
Mailing Address - Country:US
Mailing Address - Phone:443-567-6320
Mailing Address - Fax:443-327-4951
Practice Address - Street 1:4C NORTH AVE STE 403
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2333
Practice Address - Country:US
Practice Address - Phone:443-567-6320
Practice Address - Fax:443-327-4951
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4625363L00000X
MO155922363L00000X
MDR270237363LF0000X
TX1022167363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO427366802Medicaid
KS200331470AMedicaid
AZ734594Medicaid
MD223521800Medicaid