Provider Demographics
NPI:1912418252
Name:BLOOM NATURAL HEALTH, PLLC
Entity Type:Organization
Organization Name:BLOOM NATURAL HEALTH, PLLC
Other - Org Name:BLOOM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LOUDEN
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:860-310-5559
Mailing Address - Street 1:95 S MAIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2506
Mailing Address - Country:US
Mailing Address - Phone:860-310-5559
Mailing Address - Fax:860-310-5561
Practice Address - Street 1:95 S MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2506
Practice Address - Country:US
Practice Address - Phone:860-310-5559
Practice Address - Fax:860-310-5561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X
CT000259175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty