Healthcare Provider Details

I. General information

NPI: 1497596043
Provider Name (Legal Business Name): CHANCIE D HOLCOMBE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PROSPECT AVE STE 706
SYRACUSE NY
13203-1807
US

IV. Provider business mailing address

115 W 8TH ST
OSWEGO NY
13126-1409
US

V. Phone/Fax

Practice location:
  • Phone: 315-703-5200
  • Fax:
Mailing address:
  • Phone: 904-502-9822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number941907
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number002304
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: