Individual
MARY JO BLOOMINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2550 24TH ST, ROCK ISLAND, IL 61201-5304
(309) 793-4223
(309) 793-6276
Mailing address
2550 24TH ST, ROCK ISLAND, IL 61201-5304
(309) 793-4223
(309) 793-6276
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
90720
BLUE SHIELD
IA
Enumeration date
01/19/2006
Last updated
12/28/2007
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