Provider Demographics
NPI:1366007361
Name:BLOOMQUIST, CONSTANCE (RN BSN)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:BLOOMQUIST
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S BISMARK ST
Mailing Address - Street 2:
Mailing Address - City:WAUSA
Mailing Address - State:NE
Mailing Address - Zip Code:68786-2038
Mailing Address - Country:US
Mailing Address - Phone:402-586-2255
Mailing Address - Fax:402-586-2406
Practice Address - Street 1:300 S BISMARK ST
Practice Address - Street 2:
Practice Address - City:WAUSA
Practice Address - State:NE
Practice Address - Zip Code:68786-2038
Practice Address - Country:US
Practice Address - Phone:402-586-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE35916163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool