Provider Demographics
NPI:1326351453
Name:OMONDI, IZABELA MALGORZATA (NP)
Entity Type:Individual
Prefix:MRS
First Name:IZABELA
Middle Name:MALGORZATA
Last Name:OMONDI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:IZABEAL
Other - Middle Name:MALGORZATA
Other - Last Name:FANUEF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:26 QUEEN STREET
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2473
Mailing Address - Country:US
Mailing Address - Phone:508-860-7800
Mailing Address - Fax:508-860-7925
Practice Address - Street 1:26 QUEEN STREET
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2473
Practice Address - Country:US
Practice Address - Phone:508-860-7800
Practice Address - Fax:508-860-7925
Is Sole Proprietor?:No
Enumeration Date:2010-07-18
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2266427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty