Provider Demographics
NPI:1598125072
Name:BLOMBERG, BRITTANY N R (DO)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:N R
Last Name:BLOMBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:NOEL ROWE
Other - Last Name:BLOMBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:BELOIT HEALTH SYSTEM INC.
Mailing Address - Street 2:1905 E. HUEBBE PARKWAY
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-364-2293
Mailing Address - Fax:608-364-5452
Practice Address - Street 1:BELOIT CLINIC
Practice Address - Street 2:1905 E. HUEBBE PARKWAY
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1842
Practice Address - Country:US
Practice Address - Phone:608-364-2240
Practice Address - Fax:608-363-7374
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 390200000X
WI69203-21207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100103647Medicaid