Bloom, Marcene A

Bloom, Marcene A is an individual health care provider with primary practice located at 2905 5Th St , Rapid City SD 57701-7316. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Bloom, Marcene A can be contacted via phone (605) 341-7337.

Contact Information

Primary practice address
2905 5Th St Rapid City SD 57701-7316
Phone: (605) 341-7337
Fax: (605) 341-2447
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 0479 South Dakota

Profile Details

NPI number 1174538052
LBN Legal business name Bloom, Marcene A
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 29th, 2006
Last updated Feb 1st, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174538052 NPPES
South Dakota MEDICAID 6823440
South Dakota Other 0479

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