Provider Demographics
NPI:1770836587
Name:COMBS, GLORIA ANN
Entity Type:Individual
Prefix:MISS
First Name:GLORIA
Middle Name:ANN
Last Name:COMBS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:GLORIA
Other - Middle Name:ANN
Other - Last Name:COMBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CEO
Mailing Address - Street 1:1699 WEEKSVILLE RD
Mailing Address - Street 2:106 D
Mailing Address - City:ELIZABETH CTY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-7939
Mailing Address - Country:US
Mailing Address - Phone:252-505-1453
Mailing Address - Fax:
Practice Address - Street 1:1699 WEEKSVILLE RD
Practice Address - Street 2:106 D
Practice Address - City:ELIZABETH CTY
Practice Address - State:NC
Practice Address - Zip Code:27909-7939
Practice Address - Country:US
Practice Address - Phone:252-505-1453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20-0691R09374700000X
NC22727376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374700000XNursing Service Related ProvidersTechnician