Healthcare Provider Details

I. General information

NPI: 1104597111
Provider Name (Legal Business Name): ANGELINE MCCOMB NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 CINCINNATUS RD
CINCINNATUS NY
13040-9685
US

IV. Provider business mailing address

85 S WEST ST
HOMER NY
13077-1542
US

V. Phone/Fax

Practice location:
  • Phone: 607-863-4126
  • Fax:
Mailing address:
  • Phone: 607-753-3797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number359979
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: