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: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 N COLLEGE DR STE 1
CHEYENNE WY
82001-1960
US

IV. Provider business mailing address

2965 E TARPON DR STE 150
MERIDIAN ID
83642-9007
US

V. Phone/Fax

Practice location:
  • Phone: 701-516-4637
  • Fax:
Mailing address:
  • Phone: 208-287-9420
  • Fax:

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: