MEDICARE: STEPHANIE LORRAINE COMBS

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1982414645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LORRAINE COMBS

Provider Business Mailing Address
First Line	:	6685 N HOLDAWAY PL
Second Line	:
City	:	WEST TERRE HAUTE
State	:	IN
Zip	:	47885-9785
Country	:	US
Telephone Number	:	812-940-8298
Fax Number	:

Provider Business Practice Location Address
First Line	:	6685 N HOLDAWAY PL
Second Line	:
City	:	WEST TERRE HAUTE
State	:	IN
Zip	:	47885-9785
Country	:	US
Telephone Number	:	812-940-8298
Fax Number	:

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

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	01/13/2025

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