Provider Demographics
NPI:1770171076
Name:BLOOM, NATALIE ANN (ARNP, FNP-C)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANN
Last Name:BLOOM
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5060
Mailing Address - Country:US
Mailing Address - Phone:319-272-2070
Mailing Address - Fax:319-272-2077
Practice Address - Street 1:200 E RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5060
Practice Address - Country:US
Practice Address - Phone:319-272-2070
Practice Address - Fax:319-272-2077
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA161864363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner