Provider Demographics
NPI:1659488781
Name:COOMBS, ROSALY (NP)
Entity Type:Individual
Prefix:
First Name:ROSALY
Middle Name:
Last Name:COOMBS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PIONEERS MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MEEKER
Mailing Address - State:CO
Mailing Address - Zip Code:81641-3181
Mailing Address - Country:US
Mailing Address - Phone:970-878-5047
Mailing Address - Fax:970-878-3285
Practice Address - Street 1:100 PIONEERS MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MEEKER
Practice Address - State:CO
Practice Address - Zip Code:81641-3181
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO102277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC808159Medicare PIN
COS88901Medicare UPIN