Provider Demographics
NPI:1538656442
Name:BLOOM, SARAH DALTON (ARNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:DALTON
Last Name:BLOOM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13311 NE 9TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2633
Mailing Address - Country:US
Mailing Address - Phone:360-513-8089
Mailing Address - Fax:
Practice Address - Street 1:2101 NE 139TH ST STE 285
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2326
Practice Address - Country:US
Practice Address - Phone:360-839-4532
Practice Address - Fax:360-639-8432
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60816459363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily