Provider Demographics
NPI:1265205108
Name:BLOOMER, JASON COREY (MSN, RN, CCRN, FANAI)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:COREY
Last Name:BLOOMER
Suffix:
Gender:M
Credentials:MSN, RN, CCRN, FANAI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 PITT ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-4240
Mailing Address - Country:US
Mailing Address - Phone:575-308-3787
Mailing Address - Fax:505-843-8886
Practice Address - Street 1:502 ELM ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2512
Practice Address - Country:US
Practice Address - Phone:575-308-3787
Practice Address - Fax:505-843-8886
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-80349163WP2201X, 163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory CareGroup - Multi-Specialty