Healthcare Provider Details

I. General information

NPI: 1033577671
Provider Name (Legal Business Name): BLOOM MIDWIFERY AND WOMENS HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 WAKARUSA DR SUITE 400
LAWRENCE KS
66049-4090
US

IV. Provider business mailing address

1440 WAKARUSA DR STE 400
LAWRENCE KS
66049-4090
US

V. Phone/Fax

Practice location:
  • Phone: 785-832-8700
  • Fax: 888-771-8229
Mailing address:
  • Phone: 785-832-8700
  • Fax: 888-771-8229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: SUSANNAH L REED
Title or Position: MIDWIFE
Credential:
Phone: 785-832-8700