1356168710 NPI number — MRS. BRITTANY JENINNE COMBS RN

Table of content: MRS. BRITTANY JENINNE COMBS RN (NPI 1356168710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356168710 NPI number — MRS. BRITTANY JENINNE COMBS RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COMBS
Provider First Name:
BRITTANY
Provider Middle Name:
JENINNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTIN
Provider Other First Name:
BRITTANY
Provider Other Middle Name:
JENINNE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356168710
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIRKLIN
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46050-9735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-438-0871
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 S CREASY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47905-4972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-502-4412
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  28195492A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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