Healthcare Provider Details

I. General information

NPI: 1699878926
Provider Name (Legal Business Name): PATRICIA ANNE MCCOMBS RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA ANNE MCCOMBS RD, LDN

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 05/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 ROANOKE AVE ALBEMARLE REGIONAL HEALTH SERVICES
ELIZABETH CITY NC
27909
US

IV. Provider business mailing address

617 SOUTH HWY 343
CAMDEN NC
27921
US

V. Phone/Fax

Practice location:
  • Phone: 252-338-4370
  • Fax: 252-337-7911
Mailing address:
  • Phone: 252-337-6791
  • Fax: 252-337-6792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL 001484
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: