Provider Demographics
NPI:1215297239
Name:BLAGMAN, LORRAINE CLAUDIA (CRNP FAMILY HEALTH)
Entity type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:CLAUDIA
Last Name:BLAGMAN
Suffix:
Gender:F
Credentials:CRNP FAMILY HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 WOODWORTH RD
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-1913
Mailing Address - Country:US
Mailing Address - Phone:610-872-6798
Mailing Address - Fax:
Practice Address - Street 1:4021 WOODWORTH RD
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-1913
Practice Address - Country:US
Practice Address - Phone:610-872-6798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP004035B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily