Provider Demographics
NPI:1851977573
Name:FLYNN-LOMBARDI, IRENE A (NP)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:A
Last Name:FLYNN-LOMBARDI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 HARTFORD TPKE STE 106
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4760
Mailing Address - Country:US
Mailing Address - Phone:860-218-9916
Mailing Address - Fax:
Practice Address - Street 1:281 HARTFORD TPKE STE 106
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4760
Practice Address - Country:US
Practice Address - Phone:860-218-9916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT87060163W00000X
CT11726363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT87060OtherRN LICENSE