Provider Demographics
NPI:1063116168
Name:ZOMBRO, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ZOMBRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12508 WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BUNKER HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25413-3096
Mailing Address - Country:US
Mailing Address - Phone:304-901-9882
Mailing Address - Fax:
Practice Address - Street 1:12508 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BUNKER HILL
Practice Address - State:WV
Practice Address - Zip Code:25413-3096
Practice Address - Country:US
Practice Address - Phone:304-901-9882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant