Provider Demographics
NPI:1619185402
Name:BLOOMER, HELEN (RN,APN-C)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:BLOOMER
Suffix:
Gender:F
Credentials:RN,APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-2095
Mailing Address - Country:US
Mailing Address - Phone:201-891-6660
Mailing Address - Fax:
Practice Address - Street 1:303 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-2095
Practice Address - Country:US
Practice Address - Phone:201-891-6660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00001500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP75865Medicare UPIN