Provider Demographics
NPI:1629327804
Name:MCCOMB, MONICA ANN (LPN)
Entity Type:Individual
Prefix:MISS
First Name:MONICA
Middle Name:ANN
Last Name:MCCOMB
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 RT. 189
Mailing Address - Street 2:
Mailing Address - City:CHURUBUSCO
Mailing Address - State:NY
Mailing Address - Zip Code:12923
Mailing Address - Country:US
Mailing Address - Phone:518-570-8034
Mailing Address - Fax:
Practice Address - Street 1:618 STATE ROUTE 189
Practice Address - Street 2:
Practice Address - City:CHURUBUSCO
Practice Address - State:NY
Practice Address - Zip Code:12923-2309
Practice Address - Country:US
Practice Address - Phone:518-570-8034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310326164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse