Provider Demographics
NPI:1164671376
Name:UPSHAW-COMBS, DONNA (APHN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:UPSHAW-COMBS
Suffix:
Gender:F
Credentials:APHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362
Mailing Address - Country:US
Mailing Address - Phone:334-255-7260
Mailing Address - Fax:337-255-7663
Practice Address - Street 1:301 ANDREW AVE
Practice Address - Street 2:LYSTER ARMY HEALTH CLINIC
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36360-5001
Practice Address - Country:US
Practice Address - Phone:334-255-7260
Practice Address - Fax:334-255-7663
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN102633163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health