Bloom, Tisha Nikki

Bloom, Tisha Nikki is an individual health care provider with primary practice located at 8901 W Lincoln Ave , West Allis WI 53227-2409. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Bloom, Tisha Nikki can be contacted via phone (414) 489-5920.

Contact Information

Primary practice address
8901 W Lincoln Ave West Allis WI 53227-2409
Phone: (414) 489-5920
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 140392-30 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 140392-030 Wisconsin

Profile Details

NPI number 1538490370
LBN Legal business name Bloom, Tisha Nikki
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 19th, 2010
Last updated Jul 17th, 2024 - about 2 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538490370 NPPES
Wisconsin MEDICAID 100008858

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