MEDICARE: MRS. ANNE WELCH 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	363LF0000X	Family Nurse Practitioner	0024151497	VA

General Provider Information

NPI Number	:	1164461414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNE WELCH BLOOM ARNP

Provider Business Mailing Address
First Line	:	3315 N BRANDYWINE ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-2818
Country	:	US
Telephone Number	:	703-532-4994
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 WASHINGTON BLVD
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-5703
Country	:	US
Telephone Number	:	703-228-1220
Fax Number	:

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	04/03/2014

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