Provider Demographics
NPI:1376303222
Name:BLOOM FAMILY HEALTH & WELLNESS, LLC
Entity Type:Organization
Organization Name:BLOOM FAMILY HEALTH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:667-367-7545
Mailing Address - Street 1:770 OLD LIBERTY RD STE 3
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-8500
Mailing Address - Country:US
Mailing Address - Phone:667-367-7545
Mailing Address - Fax:
Practice Address - Street 1:770 OLD LIBERTY RD STE 3
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-8500
Practice Address - Country:US
Practice Address - Phone:667-367-7545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service