Provider Demographics
NPI:1952563850
Name:BOMBOLINO, LINDA ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANN
Last Name:BOMBOLINO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:ANN
Other - Last Name:SOMMER,FOSTER,RATNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 CEDAR PARK COMMONS
Mailing Address - Street 2:#17
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-2585
Mailing Address - Country:US
Mailing Address - Phone:845-794-1916
Mailing Address - Fax:
Practice Address - Street 1:20 COMMUNITY LN
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-2851
Practice Address - Country:US
Practice Address - Phone:845-292-8770
Practice Address - Fax:845-292-4298
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233761-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse