Provider Demographics
NPI:1740460500
Name:COMBS, JUANITA M (CRNA)
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:M
Last Name:COMBS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 N STATE ROUTE 101 LOT 63
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-8449
Mailing Address - Country:US
Mailing Address - Phone:333-098-0529
Mailing Address - Fax:
Practice Address - Street 1:800 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:OH
Practice Address - Zip Code:45828
Practice Address - Country:US
Practice Address - Phone:419-678-2341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN192146367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH8240961OtherMEDICARE PTAN
OH2794114Medicaid
OH000000540662OtherANTHEM
OHP00462364OtherMEDICARE RAILROAD