Provider Demographics
NPI:1699545020
Name:BLOOM IN NUTRITION SERVICES
Entity type:Organization
Organization Name:BLOOM IN NUTRITION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FASSINO
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:847-404-9978
Mailing Address - Street 1:5497 W STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-8010
Mailing Address - Country:US
Mailing Address - Phone:847-404-9978
Mailing Address - Fax:
Practice Address - Street 1:5497 W STONEWOOD DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-8010
Practice Address - Country:US
Practice Address - Phone:847-404-9978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty