Provider Demographics
NPI:1063911832
Name:COOMBS, TERESA DARLENE (RN)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:DARLENE
Last Name:COOMBS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 BENEDICTA AVE
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2005
Mailing Address - Country:US
Mailing Address - Phone:719-845-4235
Mailing Address - Fax:719-845-4241
Practice Address - Street 1:410 BENEDICTA AVE
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2005
Practice Address - Country:US
Practice Address - Phone:719-845-4235
Practice Address - Fax:719-845-4241
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0071022163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator