Healthcare Provider Details

I. General information

NPI: 1366549164
Provider Name (Legal Business Name): MS. JUDY H BLOOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3143 DORIANN DR
NORTHBROOK IL
60062-6909
US

IV. Provider business mailing address

3143 DORIANN DR
NORTHBROOK IL
60062-6909
US

V. Phone/Fax

Practice location:
  • Phone: 847-509-8443
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: