Provider Demographics
NPI:1932518289
Name:COOMBS, CASSANDRA PAIGE (LPN)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:PAIGE
Last Name:COOMBS
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 1:675 WILSON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:13811-2639
Mailing Address - Country:US
Mailing Address - Phone:607-972-4367
Mailing Address - Fax:
Practice Address - Street 1:675 WILSON CREEK RD
Practice Address - Street 2:
Practice Address - City:NEWARK VALLEY
Practice Address - State:NY
Practice Address - Zip Code:13811-2639
Practice Address - Country:US
Practice Address - Phone:607-972-4367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319165-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse