Healthcare Provider Details

I. General information

NPI: 1811221112
Provider Name (Legal Business Name): LUCY M COOMBS ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HOSPICE CIR
RALEIGH NC
27607-6372
US

IV. Provider business mailing address

250 HOSPICE CIR
RALEIGH NC
27607-6372
US

V. Phone/Fax

Practice location:
  • Phone: 919-828-0890
  • Fax: 919-719-0395
Mailing address:
  • Phone: 919-828-0890
  • Fax: 919-719-0395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number182908
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: