Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 71008334A | IN |
N | 363LA2200X | Nurse Practitioner - Adult Health | 71008334A | IN |
N | 363LG0600X | Nurse Practitioner - Gerontology | 71008334A | IN |
NPI | 1083197131 |
---|---|
Provider Name | Ms. Heather Ronelle Bloomfield |
First Address | Fort Wayne, IN 46851-0299 |
Second Address | Crown Point, IN 46307-1877 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2018 |
Last Update Date | 04/08/2020 |