Healthcare Provider Details

I. General information

NPI: 1326584509
Provider Name (Legal Business Name): BRANDY N LOMO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 03/22/2020
Certification Date: 03/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 INNIS RD
COLUMBUS OH
43224-3730
US

IV. Provider business mailing address

2365 INNIS RD
COLUMBUS OH
43224-3730
US

V. Phone/Fax

Practice location:
  • Phone: 614-416-4325
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.020384
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: