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General NPI Number Information
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NPI Number | 1174939763
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Entity Type | Individual
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Provider Name | JEREMY BLOOMFIELD
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Gender | Male
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Dates
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Enumeration Date | 07/03/2014
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Last Update Date | 04/20/2026
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Provider Practice Location Address
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Address Line | 100 N ACADEMY AVE
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City | DANVILLE
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State | PA
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Zip | 17822
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Country | US
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Telephone | 570-214-9301
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Fax | 570-271-7158
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Provider Business Mailing Address
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Address Line | PO BOX 900
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City | DANVILLE
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State | PA
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Zip | 17821-0900
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Country | US
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Telephone | 505-360-1907
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN614556
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN614556
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License Number State | PA
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