Anita Amanda Bloomingburg, CNA
Nurse's Aide in Phoenix, IL. Individual provider (NPI-1).
NPI number1407417199
StatusActive
Last updated in NPPESJul 21, 2022
Details
- NPI
- 1407417199
- Entity type
- Individual (NPI-1)
- Name
- Anita Amanda Bloomingburg
- Credential
- CNA
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 24, 2019
- Last updated
- Jul 21, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 376K00000X | Nurse's Aide | – | IL | Yes |
Practice location
829 E 153rd StPhoenix, IL 60426-2554
Phone 815-764-6631
Mailing address
5039 W 18th St Apt 17Cicero, IL 60804-1962
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