Healthcare Provider Details

I. General information

NPI: 1679495477
Provider Name (Legal Business Name): ROOTED TO BLOOM HEALTH ADVOCACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11045 W ARCH CT
MILWAUKEE WI
53224-2589
US

IV. Provider business mailing address

11045 W ARCH CT
MILWAUKEE WI
53224-2589
US

V. Phone/Fax

Practice location:
  • Phone: 414-436-3367
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. DIONNE YOUNG
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 414-708-2442