Provider Demographics
NPI:1396451290
Name:LENTZ, ALLISON BLAKE (WHNP, CNM)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:BLAKE
Last Name:LENTZ
Suffix:
Gender:F
Credentials:WHNP, CNM
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:BLAKE
Other - Last Name:GORSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19650 CLUB HOUSE ROAD
Mailing Address - Street 2:UNIT 101
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20886-3003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19650 CLUB HOUSE ROAD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20886-3003
Practice Address - Country:US
Practice Address - Phone:301-208-1300
Practice Address - Fax:240-912-5046
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCNM500003975176B00000X
DCR244923363LW0102X
MDR244923363LW0102X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health