Healthcare Provider Details

I. General information

NPI: 1326147711
Provider Name (Legal Business Name): RAYMOND M LOMBARDI NP-C, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAYMOND M LOMBARDI NP-C, FNP

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 02/29/2024
Certification Date: 09/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 E BARNETT RD
MEDFORD OR
97504-8284
US

IV. Provider business mailing address

1615 E BARNETT RD
MEDFORD OR
97504-8284
US

V. Phone/Fax

Practice location:
  • Phone: 458-225-9887
  • Fax: 866-611-1993
Mailing address:
  • Phone: 458-225-9887
  • Fax: 866-611-1993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201241586RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number370170RN
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202011093NP-PP
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC22263
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: