Provider Demographics
NPI:1528083623
Name:BLOOM, CYNTHIA STEPHENS (ARNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:STEPHENS
Last Name:BLOOM
Suffix:
Gender:F
Credentials:ARNP
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Other - First Name:
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Mailing Address - Street 1:907 WOODHURST DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-8545
Mailing Address - Country:US
Mailing Address - Phone:704-988-2572
Mailing Address - Fax:704-988-4820
Practice Address - Street 1:8500 ANDREW CARNEGIE BLVD
Practice Address - Street 2:MAIL STOP D101 LIVING WELL, HEALTH AND WELLNESS CENTER
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8500
Practice Address - Country:US
Practice Address - Phone:704-988-2572
Practice Address - Fax:704-988-4820
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC222935363LA2200X
FL1662822363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health