Healthcare Provider Details

I. General information

NPI: 1356004758
Provider Name (Legal Business Name): BLOSSOM PRYCE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CANNON PL
BRONX NY
10463-4302
US

IV. Provider business mailing address

3400 CANNON PL
BRONX NY
10463-4302
US

V. Phone/Fax

Practice location:
  • Phone: 718-796-8100
  • Fax:
Mailing address:
  • Phone: 718-796-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number770456-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: