Healthcare Provider Details

I. General information

NPI: 1497642128
Provider Name (Legal Business Name): JOHN BOMBERGER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N WEBB RD STE 3
GRAND ISLAND NE
68803-4041
US

IV. Provider business mailing address

1818 W 24TH ST APT H
KEARNEY NE
68845-0903
US

V. Phone/Fax

Practice location:
  • Phone: 402-742-0311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: