Most Relevant Information
Provider Data
| NPI Number: | 1003680919 |
| Provider Name: | MADISON BLOOM DNP, FNP-BC |
| Entity Type: | Individual |
| Taxonomy Code: | 163W00000X |
| Specialty: | Registered Nurse |
| License Number: | 4704341737 |
Most Important Dates
| Enumeration Date: | 11/10/2023 |
| Last Updated: | 09/12/2024 |
Provider Practice Location
6200 PINE HOLLOW DR STE 400
EAST LANSING
MI
488239224
Practice Location Phone/Fax
| Phone: | 5173391676 |
| Fax: |
Provider Mailing Location
10040 ROSEWOOD CT
OAK PARK
MI
482371737
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |