Healthcare Provider Details

I. General information

NPI: 1194277699
Provider Name (Legal Business Name): HEATHER COMBS PNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8761
US

IV. Provider business mailing address

1740 E SHEPHERD AVE APT 203
FRESNO CA
93720-5612
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-6022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95004799
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number9248655
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: