Organization
INBLOOM, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEONA DEICKE (CREDENTIALING MANAGER)
(203) 641-9529
Entity
Organization
Contact information
Practice address
2095 EXETER RD STE 80318, GERMANTOWN, TN 38138-3963
(901) 245-0199
Mailing address
1185 BRAYSTONE TRL, COLLIERVILLE, TN 38017-3648
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/07/2024
Last updated
06/07/2024
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