Provider Demographics
NPI:1770716318
Name:ACOMB, MONICA JEANNE (38382089)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:JEANNE
Last Name:ACOMB
Suffix:
Gender:F
Credentials:38382089
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1889 STATE ROUTE 248A
Mailing Address - Street 2:
Mailing Address - City:WHITESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14897-9739
Mailing Address - Country:US
Mailing Address - Phone:607-356-3694
Mailing Address - Fax:
Practice Address - Street 1:313 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1016
Practice Address - Country:US
Practice Address - Phone:585-596-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382089363LP0200X
NY38 382089363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics