Provider Demographics
NPI:1982414645
Name:COMBS, STEPHANIE LORRAINE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LORRAINE
Last Name:COMBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6685 N HOLDAWAY PL
Mailing Address - Street 2:
Mailing Address - City:WEST TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47885-9785
Mailing Address - Country:US
Mailing Address - Phone:812-940-8298
Mailing Address - Fax:
Practice Address - Street 1:6685 N HOLDAWAY PL
Practice Address - Street 2:
Practice Address - City:WEST TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47885-9785
Practice Address - Country:US
Practice Address - Phone:812-940-8298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant