Provider Demographics
NPI:1740262997
Name:COMBS, WANDA (RD)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:COMBS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 GORMAN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-2315
Mailing Address - Country:US
Mailing Address - Phone:606-439-2361
Mailing Address - Fax:606-439-0870
Practice Address - Street 1:441 GORMAN HOLLOW RD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-2315
Practice Address - Country:US
Practice Address - Phone:606-439-2361
Practice Address - Fax:606-439-0870
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0916133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q08882Medicare UPIN