Provider Demographics
NPI:1780008078
Name:LACOMBE, DOROTHY EILEEN (NP)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:EILEEN
Last Name:LACOMBE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:DOROTHY
Other - Middle Name:EILEEN
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:954 ROUTE 146
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12068
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:518-785-5000
Practice Address - Street 1:954 ROUTE 146
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12068
Practice Address - Country:US
Practice Address - Phone:518-337-8993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306779363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health