Individual
DANYELLE BLOOMSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED DIETITIAN
Contact information
Practice address
600 BROADWAY ST STE 120, LONGVIEW, WA 98632-3256
(360) 562-4304
(360) 562-4300
Mailing address
600 BROADWAY ST STE 120, LONGVIEW, WA 98632-3256
(360) 562-4304
(360) 562-4300
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D160807281
WA
171M00000X
Case Manager/Care Coordinator
D160807281
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417447624
—
WA
Enumeration date
05/14/2018
Last updated
09/02/2020
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