Provider Demographics
NPI:1396808333
Name:SCHOMBERG, LORI (PA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:SCHOMBERG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 SANTA FE TRL
Mailing Address - Street 2:APT. # 2042
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4719
Mailing Address - Country:US
Mailing Address - Phone:972-697-3144
Mailing Address - Fax:
Practice Address - Street 1:212 SANTA FE TRL
Practice Address - Street 2:APT. # 2042
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-4719
Practice Address - Country:US
Practice Address - Phone:972-697-3144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05074363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA05074OtherLICENSE