Healthcare Provider Details

I. General information

NPI: 1497765283
Provider Name (Legal Business Name): JOAN COMBELLICK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

YALE SCHOOL OF NURSING 400 WEST CAMPUS DRIVE
ORANGE CT
06477
US

IV. Provider business mailing address

1037 MAIN ST CREDENTIALING DEPT.
PEEKSKILL NY
10566-2913
US

V. Phone/Fax

Practice location:
  • Phone: 914-329-3397
  • Fax:
Mailing address:
  • Phone: 914-734-8858
  • Fax: 914-734-8786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number433
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number000380
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: