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General NPI Number Information
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NPI Number | 1558823617
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Entity Type | Individual
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Provider Name | JENNIFER MARIE BLOOM RN
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Gender | Female
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Dates
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Enumeration Date | 04/05/2019
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Last Update Date | 04/05/2019
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Provider Practice Location Address
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Address Line | 801 RIVERSIDE BLVD
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City | NORFOLK
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State | NE
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Zip | 68701-7420
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Country | US
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Telephone | 402-644-2429
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Fax | 402-644-2538
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Provider Business Mailing Address
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Address Line | 1106 WESTBROOK DR
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City | NORFOLK
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State | NE
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Zip | 68701-2080
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Country | US
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Telephone | 402-215-1232
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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 | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | 53710
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License Number State | NE
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