Provider Demographics
NPI:1184605081
Name:COMBS, HEIDI J (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:J
Last Name:COMBS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2114 N LINCOLN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-1028
Mailing Address - Country:US
Mailing Address - Phone:402-362-4339
Mailing Address - Fax:402-362-7743
Practice Address - Street 1:2114 N LINCOLN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-1028
Practice Address - Country:US
Practice Address - Phone:402-362-4339
Practice Address - Fax:402-362-7743
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE932363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE932OtherNEBRASKA LICENSE #
NE273926Medicare Oscar/Certification
NE932OtherNEBRASKA LICENSE #