Tanya Theresa Ivey-Bloom, CRNP
Nurse Practitioner, Family in Baltimore, MD. Individual provider (NPI-1).
NPI number1083171284
StatusActive
Last updated in NPPESOct 20, 2019
Details
- NPI
- 1083171284
- Entity type
- Individual (NPI-1)
- Name
- Tanya Theresa Ivey-Bloom
- Credential
- CRNP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Feb 23, 2019
- Last updated
- Oct 20, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | R185746 | MD | Yes |
Practice location
600 N Wolfe StBaltimore, MD 21287-0005
Phone 410-955-7531 · Fax 410-502-7711
Mailing address
600 N Wolfe StBaltimore, MD 21287-0005
Phone 410-955-7531 · Fax 410-502-7711
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