Provider Demographics
NPI:1992925721
Name:NYBERG, LORNA MAUREEN (FNP)
Entity type:Individual
Prefix:
First Name:LORNA
Middle Name:MAUREEN
Last Name:NYBERG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10332 CHARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-3076
Mailing Address - Country:US
Mailing Address - Phone:909-466-5974
Mailing Address - Fax:
Practice Address - Street 1:10332 CHARWOOD CT
Practice Address - Street 2:
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91737-3076
Practice Address - Country:US
Practice Address - Phone:909-466-5974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA328558163W00000X
CA11125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25523ZMedicaid
CAZZZ25523ZMedicaid
CAS98841Medicare PIN