MEDICARE: AMY K. BLOM RD

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	133V00000X	Registered Dietitian	DI61260721	WA
2	171M00000X	Case Manager/Care Coordinator	DI61260721	WA
3	133VN1004X	Pediatric Nutrition Registered Dietitian	DI61260721	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891422614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY K. BLOM RD

Provider Business Mailing Address
First Line	:	PO BOX 34703
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-1703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4455 CORDATA PKWY
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-8037
Country	:	US
Telephone Number	:	360-671-3225
Fax Number	:	360-671-0000

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

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	03/12/2026

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Directions to “ AMY K. BLOM RD” Practice Location

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