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NPI Code Detail

MEDICARE: MARJORIE COMBELLICK MSN, AGNPC, PMHNPBC

MEDICARE: MARJORIE COMBELLICK MSN, AGNPC, PMHNPBC
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
1363LA2200XAdult Health Nurse Practitioner71004948AIN
2363LG0600XGerontology Nurse Practitioner71004948AIN
3363LP0808XPsychiatric/Mental Health Nurse Practitioner0024185727VA
4363LP2300XPrimary Care Nurse Practitioner71004948AIN
5363LP0808XPsychiatric/Mental Health Nurse Practitioner71004948AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831504364
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARJORIE COMBELLICK MSN, AGNPC, PMHNPBC
Provider Business Mailing Address
First Line : 109 BETA DR
Second Line :
City : LAFAYETTE
State : LA
Zip : 70506-3923
Country : US
Telephone Number : 317-519-6558
Fax Number :
Provider Business Practice Location Address
First Line : 1701 MERCY HEALTH PL
Second Line :
City : CINCINNATI
State : OH
Zip : 45237-6147
Country : US
Telephone Number : 513-853-8520
Fax Number : 513-442-7695
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2014
Last Update Date : 02/21/2024

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