Provider Demographics
NPI:1841579968
Name:BLOOMFIELD, KELLI ANNE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:KELLI
Middle Name:ANNE
Last Name:BLOOMFIELD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 SCHONHARDT ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-3028
Mailing Address - Country:US
Mailing Address - Phone:419-618-3640
Mailing Address - Fax:
Practice Address - Street 1:133 SCHONHARDT ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-3028
Practice Address - Country:US
Practice Address - Phone:419-618-3640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-07
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 125980-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse