Individual
JOHNNIE BLOOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
260 BEACON ST, SOMERVILLE, MA 02143-3534
(617) 661-5700
Mailing address
260 BEACON ST, SOMERVILLE, MA 02143-3534
(617) 661-5700
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
53794
MA
Other
Enumeration date
10/26/2006
Last updated
07/08/2007
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