Provider Demographics
NPI:1235312588
Name:BLOOM, PAULA JEAN (RN IBCLC RLC)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:JEAN
Last Name:BLOOM
Suffix:
Gender:F
Credentials:RN IBCLC RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6621 SANDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3963
Mailing Address - Country:US
Mailing Address - Phone:405-464-7108
Mailing Address - Fax:405-271-6454
Practice Address - Street 1:825 NE 10TH ST # 3300
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5417
Practice Address - Country:US
Practice Address - Phone:405-271-9494
Practice Address - Fax:405-271-3727
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist