Provider Demographics
NPI:1407366701
Name:LACOMBE, DAVID (RN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LACOMBE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 JUNIPER CT
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-1100
Mailing Address - Country:US
Mailing Address - Phone:262-719-8203
Mailing Address - Fax:
Practice Address - Street 1:321 JUNIPER CT
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-1100
Practice Address - Country:US
Practice Address - Phone:262-719-8203
Practice Address - Fax:262-719-8203
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI180222-30163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine