Healthcare Provider Details

I. General information

NPI: 1932013729
Provider Name (Legal Business Name): BLOOM INTERNALLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2067 CARSON LN
MONROE MI
48162-9515
US

IV. Provider business mailing address

2067 CARSON LN
MONROE MI
48162-9515
US

V. Phone/Fax

Practice location:
  • Phone: 734-795-3044
  • Fax:
Mailing address:
  • Phone: 734-795-3044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. ALAIJAH SANIYAH DURIAH BREWER
Title or Position: DOULA
Credential:
Phone: 734-795-3044