Provider Demographics
NPI:1043976418
Name:LUMBAO, KRISTINE
Entity Type:Individual
Prefix:MISS
First Name:KRISTINE
Middle Name:
Last Name:LUMBAO
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 1:6125 FIELDSTON RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1144
Mailing Address - Country:US
Mailing Address - Phone:718-838-8429
Mailing Address - Fax:
Practice Address - Street 1:6125 FIELDSTON RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-1144
Practice Address - Country:US
Practice Address - Phone:718-838-8429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY804630163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse