Most Relevant Information
Provider Data
| NPI Number: | 1003587056 |
| Provider Name: | LISA BLOMGREN ACNPC-AG |
| Entity Type: | Individual |
| Taxonomy Code: | 363LA2100X |
| Specialty: | Nurse Practitioner |
| License Number: | NJ2601203000 |
Most Important Dates
| Enumeration Date: | 09/21/2021 |
| Last Updated: | 09/21/2021 |
Provider Practice Location
120 LINDBERGH BLVD
BLOOMFIELD
NJ
070034500
Practice Location Phone/Fax
| Phone: | 9735082697 |
| Fax: |
Provider Mailing Location
120 LINDBERGH BLVD
BLOOMFIELD
NJ
070034500
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |