Healthcare Provider Details

I. General information

NPI: 1760134555
Provider Name (Legal Business Name): ERICA COMBS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2022
Last Update Date: 01/22/2022
Certification Date: 01/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 VIENNA PKWY
DAYTON OH
45459-1486
US

IV. Provider business mailing address

701 TIMBERWOOD DR
BEAVERCREEK OH
45430-1439
US

V. Phone/Fax

Practice location:
  • Phone: 937-741-7896
  • Fax: 937-741-7897
Mailing address:
  • Phone: 937-471-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number118680
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: