Provider Demographics
NPI:1861808768
Name:DESCOMBES, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DESCOMBES
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 1:6040 ACRES RD LOT 16
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1588
Mailing Address - Country:US
Mailing Address - Phone:419-350-8263
Mailing Address - Fax:
Practice Address - Street 1:107 1/2 W ADRIAN ST
Practice Address - Street 2:
Practice Address - City:BLISSFIELD
Practice Address - State:MI
Practice Address - Zip Code:49228-1201
Practice Address - Country:US
Practice Address - Phone:419-377-6986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH436298163WP0808X
MI4703112368164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health