Jeri Rosenbloom, NP
Individual provider Active NPI Pediatric Nurse Practitioner · Fairbanks, AK
NPI 1134844749 · NPPES record last updated Oct 5, 2022
Key facts
- NPI
- 1134844749
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- 199813 (AK)
- Practice address
- 1650 Cowles St
Fairbanks, AK 99701-5907 - Phone
- (907) 452-8181
- NPI assigned
- Oct 5, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221114003033 | AK | Practitioner - Nurse Practitioner | 4183092695 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tanana Valley Clinic LLC | Current |
Accepting new patients | |
| Tanana Valley Clinic LLC | Current |
Accepting new patients | |
| Fairbanks Memorial Hospital, LLC | Past | Accepting new patients |
Locations
1650 Cowles St
Fairbanks, AK 99701
Phone (907) 452-8181
1001 Noble St
Fairbanks, AK 99701
Phone (907) 276-2806
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 199813 | AK | Yes |
Addresses
Primary practice location
1650 Cowles St
Fairbanks, AK 99701-5907
Mailing address
289 Jade St
Fairbanks, AK 99712-1832
Other providers in Fairbanks, AK
- Traci Lynn Roon
- Lisa Root
- Nikki Rosauer
- Carol J Rose
- Heidi Eileen Rose
- Danay Rosendahl
- Brenda Susan Rosenthal
- Robert L Rosentreter III
- Ruth Rosentreter
- Jacqueleen L Rosete
All providers in Fairbanks, AK · Pediatric Nurse Practitioner in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 5, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.