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General NPI Number Information
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NPI Number | 1396616454
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Entity Type | Organization
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Legal Business Name | INWARD BLOOM PLLC
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Dates
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Enumeration Date | 09/12/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 368 KINTNER RD
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City | KINTNERSVILLE
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State | PA
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Zip | 18930-9725
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Country | US
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Telephone | 714-497-3469
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5
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City | KINTNERSVILLE
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State | PA
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Zip | 18930-0005
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARYANNA STAERK
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Credential | MBA, LDN
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Telephone | 714-497-3469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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