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General NPI Number Information
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NPI Number | 1497621288
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Entity Type | Organization
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Legal Business Name | BLOOM HEALTH & WELLNESS
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Dates
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Enumeration Date | 10/16/2025
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 815 W MAIN ST
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City | MITCHELL
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State | IN
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Zip | 47446-1307
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Country | US
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Telephone | 812-583-4273
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Fax |
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Provider Business Mailing Address
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Address Line | 166 MAPLE RUN ESTATES BLVD
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City | SPRINGVILLE
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State | IN
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Zip | 47462-5419
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Country | US
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Telephone | 812-583-4273
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE FRYE
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Credential | FNP-C
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Telephone | 812-583-4273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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