Provider Demographics
NPI:1568901221
Name:LOMBARDO, CARMEN (ACNP, DNP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:LOMBARDO
Suffix:
Gender:F
Credentials:ACNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5202 W MONTE CRISTO AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-2507
Mailing Address - Country:US
Mailing Address - Phone:602-863-6206
Mailing Address - Fax:
Practice Address - Street 1:2145 W SOUTHERN AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4715
Practice Address - Country:US
Practice Address - Phone:623-327-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7607363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care