Healthcare Provider Details

I. General information

NPI: 1255106415
Provider Name (Legal Business Name): EMILY LOUISE BLOOMFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY HALL

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29777 TELEGRAPH RD
SOUTHFIELD MI
48034-1303
US

IV. Provider business mailing address

29777 TELEGRAPH RD
SOUTHFIELD MI
48034-1303
US

V. Phone/Fax

Practice location:
  • Phone: 352-414-0372
  • Fax:
Mailing address:
  • Phone: 352-414-0372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704357162
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: