Individual
ETHAN RANDALL BLOMBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NREMT-P
Contact information
Practice address
6103 WICKHAM AVE, FORT CAMPBELL, KY 42223-5425
(715) 657-0985
Mailing address
6103 WICKHAM AVE, FORT CAMPBELL, KY 42223-5425
(715) 657-0985
Taxonomy
Speciality
Code
Description
License number
State
146L00000X
Paramedic
Primary
P032566
GA
Other
Enumeration date
04/14/2026
Last updated
04/14/2026
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