Provider Demographics
NPI:1275366072
Name:BLOOMING WOMENS WELLNESS
Entity type:Organization
Organization Name:BLOOMING WOMENS WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARBER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BFC
Authorized Official - Phone:903-736-9722
Mailing Address - Street 1:PO BOX 1196
Mailing Address - Street 2:
Mailing Address - City:GILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75644-1196
Mailing Address - Country:US
Mailing Address - Phone:903-736-9722
Mailing Address - Fax:
Practice Address - Street 1:5505 US HWY 271 N
Practice Address - Street 2:
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75644
Practice Address - Country:US
Practice Address - Phone:903-736-9722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center