Individual
SHARI BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1665 BONANZA DR, PARK CITY, UT 84060-5127
(435) 649-7640
(435) 649-1365
Mailing address
PO BOX 27128, SALK LAKE CITY, UT 84127-0128
(801) 491-6482
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363LF0000X
Family Nurse Practitioner
MT0903117
UT
Other
Enumeration date
11/03/2008
Last updated
09/04/2012
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