MEDICARE: JODI BLOOMSTON CRNA

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	367500000X	Certified Registered Nurse Anesthetist	1-087817	AL

General Provider Information

NPI Number	:	1801849187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI BLOOMSTON CRNA

Provider Business Mailing Address
First Line	:	PO BOX 757
Second Line	:
City	:	FLORENCE
State	:	AL
Zip	:	35631-0757
Country	:	US
Telephone Number	:	256-764-9697
Fax Number	:	256-764-9699

Provider Business Practice Location Address
First Line	:	2621 19TH ST S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-1913
Country	:	US
Telephone Number	:	205-322-3332
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	11/11/2020

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Directions to “ JODI BLOOMSTON CRNA” Practice Location

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