Provider Demographics
NPI:1760750368
Name:BLOOMFIELD, DARIN WESLEY (CRNA, MHS)
Entity Type:Individual
Prefix:MR
First Name:DARIN
Middle Name:WESLEY
Last Name:BLOOMFIELD
Suffix:
Gender:M
Credentials:CRNA, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:UT
Mailing Address - Zip Code:84624-8944
Mailing Address - Country:US
Mailing Address - Phone:801-391-3810
Mailing Address - Fax:
Practice Address - Street 1:126 WHITE SAGE AVE
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:UT
Practice Address - Zip Code:84624-8937
Practice Address - Country:US
Practice Address - Phone:435-864-5591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6800670-4406367500000X
UT6800670-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse