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General NPI Number Information
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NPI Number | 1962924217
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Entity Type | Organization
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Legal Business Name | BLOOM SKIN NUTRITION, LLC
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Dates
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Enumeration Date | 07/07/2017
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 14593 WINDWAY DR
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City | GRAND HAVEN
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State | MI
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Zip | 49417-7677
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Country | US
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Telephone | 636-345-2375
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Fax |
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Provider Business Mailing Address
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Address Line | 14593 WINDWAY DR
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City | GRAND HAVEN
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State | MI
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Zip | 49417-7677
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Country | US
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Telephone | 636-345-2375
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Fax |
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Authorized Official
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Title or Position | PRACTITIONER / OWNER
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Name | HEIDI PAULSEN
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Credential | RDN, ATC
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Telephone | 636-345-2375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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