Provider Demographics
NPI:1588121495
Name:LOMBARDI, ANDREA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:LOMBARDI
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 1:16 KENFIELD LN
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-1509
Mailing Address - Country:US
Mailing Address - Phone:786-302-0460
Mailing Address - Fax:
Practice Address - Street 1:16 KENFIELD LN
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-1509
Practice Address - Country:US
Practice Address - Phone:786-302-0460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT082668163WG0600X
CT8140363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontology