Provider Demographics
NPI:1255663837
Name:COMBERGER, PATIENCE MARIE
Entity Type:Individual
Prefix:MRS
First Name:PATIENCE
Middle Name:MARIE
Last Name:COMBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45146-0207
Mailing Address - Country:US
Mailing Address - Phone:937-728-9002
Mailing Address - Fax:
Practice Address - Street 1:69 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45146-0207
Practice Address - Country:US
Practice Address - Phone:937-728-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 135919 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse