Provider Demographics
NPI:1104914860
Name:COOMBS, AMY M (ARNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:COOMBS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHATTUCK WAY
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03801-8004
Mailing Address - Country:US
Mailing Address - Phone:603-431-6677
Mailing Address - Fax:
Practice Address - Street 1:100 SHATTUCK WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWINGTON
Practice Address - State:NH
Practice Address - Zip Code:03801-8004
Practice Address - Country:US
Practice Address - Phone:603-431-6677
Practice Address - Fax:603-610-2232
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03071721163W00000X
NH0307172303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME242310099Medicaid
NH80000258Medicaid
NH80000258Medicaid
NP0258Medicare PIN
NH80000258Medicaid