MEDICARE: EMILY GRACE LABOMBARD MPH, RDN, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	5672	MA

General Provider Information

NPI Number	:	1063139764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY GRACE LABOMBARD MPH, RDN, LDN

Provider Business Mailing Address
First Line	:	26 WORCESTER ST APT 202
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02118-3376
Country	:	US
Telephone Number	:	978-877-9548
Fax Number	:

Provider Business Practice Location Address
First Line	:	6156 ROCKVILLE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-3806
Country	:	US
Telephone Number	:	719-684-5754
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	10/24/2022

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