Healthcare Provider Details

I. General information

NPI: 1730412214
Provider Name (Legal Business Name): KAREN SHATKIN BLOOMFIELD M.S., R.N., C.N.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1877 PINE CONE CIR
CHARLOTTESVILLE VA
22901-8932
US

IV. Provider business mailing address

1877 PINE CONE CIR
CHARLOTTESVILLE VA
22901-8932
US

V. Phone/Fax

Practice location:
  • Phone: 434-825-0974
  • Fax: 434-924-4576
Mailing address:
  • Phone: 434-825-0974
  • Fax: 434-924-4576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number0015000235
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: