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NPI Code Detail

MEDICARE: MICHELLE BLOOM NP-C

MEDICARE: MICHELLE BLOOM NP-C
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
1363LA2200XAdult Health Nurse PractitionerRN.341314OH
2363LA2200XAdult Health Nurse Practitioner4704295279MI

General Provider Information

NPI Number : 1093094419
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE BLOOM NP-C
Provider Business Mailing Address
First Line : 4020 MORSE XING
Second Line :
City : COLUMBUS
State : OH
Zip : 43219-6037
Country : US
Telephone Number : 614-472-8491
Fax Number :
Provider Business Practice Location Address
First Line : 4020 MORSE XING
Second Line :
City : COLUMBUS
State : OH
Zip : 43219-6037
Country : US
Telephone Number : 614-472-8491
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2011
Last Update Date : 01/14/2016

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Directions to “ MICHELLE BLOOM NP-C” Practice Location

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