Healthcare Provider Details

I. General information

NPI: 1700696432
Provider Name (Legal Business Name): JENNIFER LOMBARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER BRASINGTON

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date: 07/25/2025
Reactivation Date: 12/16/2025

III. Provider practice location address

303 E KEARSLEY ST
FLINT MI
48502-1907
US

IV. Provider business mailing address

303 E KEARSLEY ST
FLINT MI
48502-1907
US

V. Phone/Fax

Practice location:
  • Phone: 810-762-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704374600
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704374600
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: