Provider Demographics
NPI:1760134555
Name:COMBS, ERICA (LPN)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:COMBS
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 1:701 TIMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45430-1439
Mailing Address - Country:US
Mailing Address - Phone:937-471-2720
Mailing Address - Fax:
Practice Address - Street 1:2510 VIENNA PKWY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-1486
Practice Address - Country:US
Practice Address - Phone:937-741-7896
Practice Address - Fax:937-741-7897
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-22
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH118680164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN.118680-IVOtherOHIO BOARD OF NURSING