Provider Demographics
NPI:1912551649
Name:MCOMBER, JOAN
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:MCOMBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:MCOMBER
Other - Last Name:FORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1130 NW HARRIMAN ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-1977
Mailing Address - Country:US
Mailing Address - Phone:541-322-7400
Mailing Address - Fax:
Practice Address - Street 1:1130 NW HARRIMAN ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-1977
Practice Address - Country:US
Practice Address - Phone:541-322-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator