Provider Demographics
NPI:1619272259
Name:COULOMBE, LISA (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:COULOMBE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 SEA VIEW AVE
Mailing Address - Street 2:20 SEA VIEW AVE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-1546
Mailing Address - Country:US
Mailing Address - Phone:585-490-8018
Mailing Address - Fax:
Practice Address - Street 1:20 SEA VIEW AVE
Practice Address - Street 2:20 SEA VIEW AVE
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-1546
Practice Address - Country:US
Practice Address - Phone:585-490-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63009513747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider