Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN 275087/NP 8833 | CA |
NPI | 1063511160 |
---|---|
Provider Name | Leslie Ann Bloomquist |
First Address | Bakersfield, CA 93314-9463 |
Second Address | Bakersfield, CA 93309-7032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S72569 | (02) | CA |