Provider Demographics
NPI:1255680393
Name:BLOOM, SHELLEY ERLINE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ERLINE
Last Name:BLOOM
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 I ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-2314
Mailing Address - Country:US
Mailing Address - Phone:916-441-2811
Mailing Address - Fax:
Practice Address - Street 1:420 I ST
Practice Address - Street 2:SUITE 7
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-2314
Practice Address - Country:US
Practice Address - Phone:916-441-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21841363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily