Provider Demographics
NPI:1942720735
Name:LOMBARDO, THERESA M (APNP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:LOMBARDO
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20611 WATERTOWN RD STE J
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1871
Mailing Address - Country:US
Mailing Address - Phone:262-928-5900
Mailing Address - Fax:
Practice Address - Street 1:20611 WATERTOWN RD STE J
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1871
Practice Address - Country:US
Practice Address - Phone:262-928-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7685363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner