Provider Demographics
NPI:1144469099
Name:BLOOM, KAREN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:BLOOM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9226 147TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:98252-9231
Mailing Address - Country:US
Mailing Address - Phone:360-981-1459
Mailing Address - Fax:360-657-3268
Practice Address - Street 1:1630 GROVE ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4302
Practice Address - Country:US
Practice Address - Phone:360-653-3500
Practice Address - Fax:360-657-3268
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60074107363LA2200X, 363LF0000X
WIRN00150675163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse