MEDICARE: BLOOM WOMENS HEALTHCARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner

General Provider Information

NPI Number	:	1922891597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOM WOMENS HEALTHCARE PLLC

Provider Business Mailing Address
First Line	:	143 W KELLOGG RD STE 2
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-8009
Country	:	US
Telephone Number	:	564-565-0338
Fax Number	:	800-420-8703

Provider Business Practice Location Address
First Line	:	143 W KELLOGG RD STE 2
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-8009
Country	:	US
Telephone Number	:	564-565-0338
Fax Number	:	800-420-8703

Authorized Official
Title or Position	:	CREDENTIALING CONSULTANT
Name	:	JULIE READ
Credential	:
Telephone Number	:	208-957-3771

Provider Enumeration Date	:	05/27/2025
Last Update Date	:	12/29/2025

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