Provider Demographics
NPI:1396616454
Name:INWARD BLOOM PLLC
Entity type:Organization
Organization Name:INWARD BLOOM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAERK
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, LDN
Authorized Official - Phone:714-497-3469
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:KINTNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18930-0005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:368 KINTNER RD
Practice Address - Street 2:
Practice Address - City:KINTNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18930-9725
Practice Address - Country:US
Practice Address - Phone:714-497-3469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty