Healthcare Provider Details

I. General information

NPI: 1780996710
Provider Name (Legal Business Name): ILONA BLUMBERG CNM,ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S SEACREST BLVD SUITE 220
BOYNTON BEACH FL
33435-7960
US

IV. Provider business mailing address

2800 S SEACREST BLVD SUITE 220
BOYNTON BEACH FL
33435-7960
US

V. Phone/Fax

Practice location:
  • Phone: 561-742-3929
  • Fax: 561-742-3931
Mailing address:
  • Phone: 561-742-3929
  • Fax: 561-742-3931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP2043362
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: