Healthcare Provider Details

I. General information

NPI: 1760852412
Provider Name (Legal Business Name): JOY COMINGORE RN, BSN, CPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 E CHESTNUT ST
LOUISVILLE KY
40202-1821
US

IV. Provider business mailing address

231 E CHESTNUT ST
LOUISVILLE KY
40202-1821
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-2113
  • Fax: 502-629-2220
Mailing address:
  • Phone: 502-629-2113
  • Fax: 502-629-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number1058714
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: