Provider Demographics
NPI:1326147711
Name:LOMBARDI, RAYMOND M (NP-C, FNP)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:M
Last Name:LOMBARDI
Suffix:
Gender:M
Credentials:NP-C, FNP
Other - Prefix:
Other - First Name:RAYMOND
Other - Middle Name:M
Other - Last Name:LOMBARDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C, FNP
Mailing Address - Street 1:1615 E BARNETT RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8284
Mailing Address - Country:US
Mailing Address - Phone:458-225-9887
Mailing Address - Fax:866-611-1993
Practice Address - Street 1:1615 E BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8284
Practice Address - Country:US
Practice Address - Phone:458-225-9887
Practice Address - Fax:866-611-1993
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201241586RN163W00000X
OH370170RN163W00000X
OR202011093NP-PP363LF0000X
CADC22263111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA350043216OtherRAIL ROAD MEDICARE
CA350043216OtherRAIL ROAD MEDICARE
CADC0222630Medicare ID - Type Unspecified