Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | NJ2601203000 | NJ |
NPI | 1003587056 |
---|---|
Provider Name | Lisa Blomgren |
First Address | Bloomfield, NJ 07003-4500 |
Second Address | Bloomfield, NJ 07003-4500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2021 |
Last Update Date | 21/09/2021 |