Provider Demographics
NPI:1649503384
Name:COMBS, TRACY JEAN (LPN)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:JEAN
Last Name:COMBS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:JEAN
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:88 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-3110
Mailing Address - Country:US
Mailing Address - Phone:937-738-7730
Mailing Address - Fax:
Practice Address - Street 1:88 COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-3110
Practice Address - Country:US
Practice Address - Phone:937-738-7730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN077637164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse