MEDICARE: ANGELA MARIE LINDBLOOM CNS

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	364SA2200X	Adult Health Clinical Nurse Specialist	2013020031	MI

General Provider Information

NPI Number	:	1932884699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MARIE LINDBLOOM CNS

Provider Business Mailing Address
First Line	:	27502 BERKSHIRE HILLS PL
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91354-1829
Country	:	US
Telephone Number	:	734-612-7993
Fax Number	:

Provider Business Practice Location Address
First Line	:	27502 BERKSHIRE HILLS PL
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91354-1829
Country	:	US
Telephone Number	:	734-612-7993
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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