Healthcare Provider Details

I. General information

NPI: 1093864076
Provider Name (Legal Business Name): JAMIE M COMBS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

IV. Provider business mailing address

8820 TILBURY DR
WILMINGTON NC
28411-8942
US

V. Phone/Fax

Practice location:
  • Phone: 910-452-8100
  • Fax:
Mailing address:
  • Phone: 910-686-9564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number86559
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: