Provider Demographics
NPI:1659689305
Name:BLOOMFIELD-MARTIN, CARMEN LYNN (LMP)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:LYNN
Last Name:BLOOMFIELD-MARTIN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:24160 NE SR-3
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-1300
Mailing Address - Country:US
Mailing Address - Phone:360-205-3085
Mailing Address - Fax:360-275-2007
Practice Address - Street 1:24160 NE STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-9626
Practice Address - Country:US
Practice Address - Phone:360-205-3085
Practice Address - Fax:360-275-2007
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60161698174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist