Provider Demographics
NPI:1588401780
Name:COOMBS, LIA (CRNP)
Entity type:Individual
Prefix:
First Name:LIA
Middle Name:
Last Name:COOMBS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 CAMPBELL BLVD STE L&M
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4968
Mailing Address - Country:US
Mailing Address - Phone:410-870-3808
Mailing Address - Fax:
Practice Address - Street 1:5020 CAMPBELL BLVD STE L&M
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4968
Practice Address - Country:US
Practice Address - Phone:410-870-3808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR154053363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily