Provider Demographics
NPI:1487842977
Name:LOMBOY, MARYGRACE K (MSN, CRNP)
Entity Type:Individual
Prefix:
First Name:MARYGRACE
Middle Name:K
Last Name:LOMBOY
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 LAKELAND CT
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-8374
Mailing Address - Country:US
Mailing Address - Phone:717-569-7207
Mailing Address - Fax:
Practice Address - Street 1:26 LAKELAND CT
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-8374
Practice Address - Country:US
Practice Address - Phone:717-569-7207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009555363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily