Individual
MRS. CARA LORENA BLOODWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NNP
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2088
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
163WN0002X
Neonatal Intensive Care Registered Nurse
R856212
MS
363L00000X
Nurse Practitioner
Primary
70472
ID
363LN0000X
Neonatal Nurse Practitioner
R856212
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00053778
—
MS
05
—
06576541
—
MS
Enumeration date
04/25/2008
Last updated
03/15/2022
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