Healthcare Provider Details

I. General information

NPI: 1902443096
Provider Name (Legal Business Name): JENNIFER LOMBARDI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2019
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 GEORGE JACKSON RD
MAUPIN OR
97037-9208
US

IV. Provider business mailing address

PO BOX 219
MAUPIN OR
97037-0219
US

V. Phone/Fax

Practice location:
  • Phone: 541-395-2911
  • Fax: 541-395-2912
Mailing address:
  • Phone: 541-395-2911
  • Fax: 541-395-2912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number44908
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: