Healthcare Provider Details

I. General information

NPI: 1366007361
Provider Name (Legal Business Name): CONSTANCE BLOOMQUIST RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S BISMARK ST
WAUSA NE
68786-2038
US

IV. Provider business mailing address

300 S BISMARK ST
WAUSA NE
68786-2038
US

V. Phone/Fax

Practice location:
  • Phone: 402-586-2255
  • Fax:
Mailing address:
  • Phone: 402-586-2255
  • Fax: 402-586-2406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number35916
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: