Provider Demographics
NPI:1154547875
Name:BLOOMCAMP, KIMBERLY (APRN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:BLOOMCAMP
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:BRANDL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:757 PARK AVE W STE 2800
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2557
Mailing Address - Country:US
Mailing Address - Phone:847-941-7600
Mailing Address - Fax:847-941-7697
Practice Address - Street 1:757 PARK AVE W
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2556
Practice Address - Country:US
Practice Address - Phone:847-941-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006104367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041315130OtherRN STATE LICENSE
IL209006104OtherAPN STATE LICENSE
IL041315130Medicaid
406120022OtherPTAN