Individual
MS. JUDITH ANNE BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
330 BROOKLINE AVENUE, CCE 200, BOSTON, MA 02215
(617) 667-0245
Mailing address
1600 BEACON STREET, APARTMENT 207, BROOKLINE, MA 02446
(617) 312-6904
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
186810
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0706442
—
MA
Enumeration date
01/08/2007
Last updated
07/08/2007
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