Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | 17-1681 | AZ |
Y | 175F00000X | Naturopath | 61015964 | WA |
N | 175L00000X | Homeopath | 4397 | OR |
NPI | 1356859466 |
---|---|
Provider Name | Laura Lee Bloom |
First Address | Vancouver, WA 98682-4213 |
Second Address | Vancouver, WA 98685-2799 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2018 |
Last Update Date | 13/10/2021 |