Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 132875 | MT |
NPI | 1023586377 |
---|---|
Provider Name | Mrs. Eleanor Stacey Combs |
First Address | Butte, MT 59701-7318 |
Second Address | Butte, MT 59701-7318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2018 |
Last Update Date | 05/11/2018 |