MEDICARE: CACTUS BLOOM STUDIO

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1316742992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CACTUS BLOOM STUDIO

Provider Business Mailing Address
First Line	:	18451 E AUBREY GLEN RD
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-3626
Country	:	US
Telephone Number	:	480-332-9729
Fax Number	:

Provider Business Practice Location Address
First Line	:	8950 E GERMANN RD # 15
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-5301
Country	:	US
Telephone Number	:	480-477-4467
Fax Number	:	480-781-4896

Authorized Official
Title or Position	:	OWNER
Name	:	MISTY SHEARER
Credential	:	FNP
Telephone Number	:	480-332-9729

Provider Enumeration Date	:	02/17/2025
Last Update Date	:	02/17/2025

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Directions to “CACTUS BLOOM STUDIO ” Practice Location

Language	Start Address	Practice Location

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