Provider Demographics
NPI:1245423912
Name:BLOOM, TERESA BARBARA (RN)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:BARBARA
Last Name:BLOOM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S M 52
Mailing Address - Street 2:
Mailing Address - City:WEBBERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48892-9260
Mailing Address - Country:US
Mailing Address - Phone:517-521-3540
Mailing Address - Fax:
Practice Address - Street 1:700 S M 52
Practice Address - Street 2:
Practice Address - City:WEBBERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48892-9260
Practice Address - Country:US
Practice Address - Phone:517-521-3540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704208979163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health