Healthcare Provider Details

I. General information

NPI: 1992163265
Provider Name (Legal Business Name): EMILY BOMBARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DRAKE DR
GREENLAND NH
03840-2112
US

IV. Provider business mailing address

10 DRAKE DR
GREENLAND NH
03840-2112
US

V. Phone/Fax

Practice location:
  • Phone: 603-828-7089
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number055979-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: