Provider Demographics
NPI:1417551441
Name:GOMBASH, VANESSA L
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:L
Last Name:GOMBASH
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 1:40 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:RICHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:43344-1274
Mailing Address - Country:US
Mailing Address - Phone:614-747-6431
Mailing Address - Fax:
Practice Address - Street 1:40 GEORGE ST
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43344-1274
Practice Address - Country:US
Practice Address - Phone:614-747-6431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8003161376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH8003161OtherDODD PROVIDER NUMBER