Provider Demographics
NPI:1932884699
Name:LINDBLOOM, ANGELA MARIE (CNS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:LINDBLOOM
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27502 BERKSHIRE HILLS PL
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1829
Mailing Address - Country:US
Mailing Address - Phone:734-612-7993
Mailing Address - Fax:
Practice Address - Street 1:27502 BERKSHIRE HILLS PL
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91354-1829
Practice Address - Country:US
Practice Address - Phone:734-612-7993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2013020031364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health