Individual
KIM BLOOMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
40 LA RIVIERE DR, BUFFALO, NY 14202-4344
(716) 893-1010
Mailing address
6835 FORESTVIEW DR, LOCKPORT, NY 14094-7988
(716) 930-4422
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
005364-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005364-1
NEW YORK STATE
NY
Enumeration date
09/11/2018
Last updated
09/11/2018
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