Individual
MICHAEL BOMBARDIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
321C POPLAR DR, PETERSBURG, VA 23805-9306
(804) 733-5591
Mailing address
321C POPLAR DR, PETERSBURG, VA 23805-9306
(804) 733-5591
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001235974
VA
363LF0000X
Family Nurse Practitioner
Primary
0024175011
VA
Other
Enumeration date
08/09/2017
Last updated
12/07/2017
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