Provider Demographics
NPI:1588695787
Name:BLACK, LORIANE (CRNP)
Entity type:Individual
Prefix:
First Name:LORIANE
Middle Name:
Last Name:BLACK
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:118 WESTMINSTER PIKE
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1060
Practice Address - Country:US
Practice Address - Phone:410-876-0086
Practice Address - Fax:410-702-7168
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR089387363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419712700Medicaid
MD419712700Medicaid
MDP00879749Medicare PIN
MD183380Y3WMedicare PIN