| NPI | 1669831657 |
|---|---|
| Former Name | BETHANY MARIE BLOOM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA11052) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ND 1295303) |
| Enumeration Date | 2016-02-18 |
| Last Update Date | 2022-02-07 |