Provider Demographics
NPI:1609965425
Name:MCCOMBS, MARILYN SUE (CRNA)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:SUE
Last Name:MCCOMBS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:SUE
Other - Last Name:SHEPHERD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2000 EOFF ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3823
Mailing Address - Country:US
Mailing Address - Phone:304-234-8663
Mailing Address - Fax:304-234-8960
Practice Address - Street 1:90 N 4TH ST
Practice Address - Street 2:
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1648
Practice Address - Country:US
Practice Address - Phone:740-633-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02940367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0066253000Medicaid
OH0780598Medicaid
WV0066253000Medicaid
OH7288551Medicare ID - Type Unspecified