Healthcare Provider Details

I. General information

NPI: 1649675158
Provider Name (Legal Business Name): SHARON BOMBARDO RN PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 2ND ST NE
MINNEAPOLIS MN
55418-4306
US

IV. Provider business mailing address

1800 2ND ST NE
MINNEAPOLIS MN
55418-4306
US

V. Phone/Fax

Practice location:
  • Phone: 612-789-1236
  • Fax: 612-706-5509
Mailing address:
  • Phone: 612-789-1236
  • Fax: 612-706-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR108201-4
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: