Individual
JORDAN BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, BSN, APRN, CRNA
Contact information
Practice address
6362 207TH ST N, FOREST LAKE, MN 55025-8022
(763) 777-0925
Mailing address
6643 N HAMILTON CIR, OLIVE BRANCH, MS 38654-7150
(763) 777-0925
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
30535
TN
Other
Enumeration date
12/01/2020
Last updated
09/30/2021
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