Provider Demographics
NPI:1659865962
Name:DOROTHY LACOMBE ADULT HEALTHCARE NURSE PRACTITIONER PLLC
Entity Type:Organization
Organization Name:DOROTHY LACOMBE ADULT HEALTHCARE NURSE PRACTITIONER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LACOMBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-337-8993
Mailing Address - Street 1:954 RT 146
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:954 RT 146
Practice Address - Street 2:SUITE 3
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:518-337-8993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty