Individual
TANYA THERESA IVEY-BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
600 N WOLFE ST, BALTIMORE, MD 21287-0005
(410) 955-7531
(410) 502-7711
Mailing address
600 N WOLFE ST, BALTIMORE, MD 21287-0005
(410) 955-7531
(410) 502-7711
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R185746
MD
Other
Enumeration date
02/23/2019
Last updated
10/20/2019
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