Annie Bloom
Individual provider Active NPI Specialist · Rapid City, SD
NPI 1306433792 · NPPES record last updated Nov 19, 2024
Key facts
- NPI
- 1306433792
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- Practice address
- 1836 W Kansas City St
Rapid City, SD 57702-2516 - Phone
- (605) 430-5217
- NPI assigned
- Dec 31, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Yes |
Addresses
Primary practice location
1836 W Kansas City St
Rapid City, SD 57702-2516
Mailing address
928 Spring Valley Dr
Divide, CO 80814-9619
Phone (605) 430-5217
Other providers in Rapid City, SD
- E David Blickensderfer
- Jill Blickensderfer
- William C Blickensderfer
- Riley Block
- Molly Bloemendaal
- Jeffrey T Bloom
- Marcene A Bloom
- Blossom Therapy LLC
- Laura Blote
- Shannon Michelle Blotske
All providers in Rapid City, SD · Specialist in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.