Provider Demographics
NPI:1447857453
Name:COOMBER, MARY H T
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:H T
Last Name:COOMBER
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 1:94 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3853
Mailing Address - Country:US
Mailing Address - Phone:919-344-3639
Mailing Address - Fax:
Practice Address - Street 1:94 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3853
Practice Address - Country:US
Practice Address - Phone:919-344-3639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR36071163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care