Provider Demographics
NPI:1518173087
Name:BLOOM, BOBBYJO (RN, IBCLC, CCE)
Entity Type:Individual
Prefix:MRS
First Name:BOBBYJO
Middle Name:
Last Name:BLOOM
Suffix:
Gender:F
Credentials:RN, IBCLC, CCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 RANGE RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-3923
Mailing Address - Country:US
Mailing Address - Phone:203-210-5246
Mailing Address - Fax:
Practice Address - Street 1:209 RANGE RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-3923
Practice Address - Country:US
Practice Address - Phone:301-807-3508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR143852163WL0100X
CT087534163WL0100X
MD101-17052163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant