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General NPI Number Information
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NPI Number | 1528083623
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Entity Type | Individual
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Provider Name | CYNTHIA STEPHENS BLOOM ARNP
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Gender | Female
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 10/02/2008
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Provider Practice Location Address
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Address Line | 8500 ANDREW CARNEGIE BLVD MAIL STOP D101 LIVING WELL, HEALTH AND WELLNESS CENTER
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City | CHARLOTTE
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State | NC
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Zip | 28262-8500
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Country | US
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Telephone | 704-988-2572
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Fax | 704-988-4820
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Provider Business Mailing Address
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Address Line | 907 WOODHURST DR
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City | MONROE
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State | NC
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Zip | 28110-8545
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Country | US
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Telephone | 704-988-2572
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Fax | 704-988-4820
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 222935
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 1662822
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License Number State | FL
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