Provider Demographics
NPI:1518599398
Name:BLOEMSMA-MORRIS, MARYANN (LVN)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:BLOEMSMA-MORRIS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 WARING CT STE A
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4509
Mailing Address - Country:US
Mailing Address - Phone:760-305-7528
Mailing Address - Fax:760-509-4410
Practice Address - Street 1:3230 WARING CT STE A
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4509
Practice Address - Country:US
Practice Address - Phone:760-305-7528
Practice Address - Fax:760-509-4410
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN702757164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty