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NPI Code Detail

MEDICARE: JENNIFER ANN BLOOM RN

MEDICARE: JENNIFER ANN BLOOM RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse126364IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
207466OTHERIAWELLMARK BC BS

General Provider Information

NPI Number : 1023353604
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ANN BLOOM RN
Provider Business Mailing Address
First Line : 255 E PACES FERRY RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30305-2233
Country : US
Telephone Number : 404-671-4000
Fax Number : 515-573-7898
Provider Business Practice Location Address
First Line : 255 E PACES FERRY RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30305-2233
Country : US
Telephone Number : 404-671-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2012
Last Update Date : 11/30/2022

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