Provider Demographics
NPI:1023586377
Name:COMBS, ELEANOR STACEY (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:STACEY
Last Name:COMBS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-7318
Mailing Address - Country:US
Mailing Address - Phone:406-723-7176
Mailing Address - Fax:
Practice Address - Street 1:101 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-7318
Practice Address - Country:US
Practice Address - Phone:406-723-7176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT132875363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health