MEDICARE: MRS. KAREN BLOOM ARNP

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
1	363LA2200X	Adult Health Nurse Practitioner	AP60074107	WA
2	363LF0000X	Family Nurse Practitioner	AP60074107	WA
3	163W00000X	Registered Nurse	RN00150675	WI

General Provider Information

NPI Number	:	1144469099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAREN BLOOM ARNP

Provider Business Mailing Address
First Line	:	9226 147TH AVE NE
Second Line	:
City	:	GRANITE FALLS
State	:	WA
Zip	:	98252-9231
Country	:	US
Telephone Number	:	360-981-1459
Fax Number	:	360-657-3268

Provider Business Practice Location Address
First Line	:	1630 GROVE ST
Second Line	:
City	:	MARYSVILLE
State	:	WA
Zip	:	98270-4302
Country	:	US
Telephone Number	:	360-653-3500
Fax Number	:	360-657-3268

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2009
Last Update Date	:	02/23/2017

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