MEDICARE: MCKENZIE ROSE COMBA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1548810575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKENZIE ROSE COMBA PA-C

Provider Business Mailing Address
First Line	:	1838 PANACA DR
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-4839
Country	:	US
Telephone Number	:	775-741-5491
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 MEDICAL PKWY
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4654
Country	:	US
Telephone Number	:	775-445-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	09/11/2019

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Directions to “ MCKENZIE ROSE COMBA PA-C” Practice Location

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