Healthcare Provider Details

I. General information

NPI: 1255695912
Provider Name (Legal Business Name): ANTONETTE M COMEAU N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 WORCESTER ST SUITE 3
SPRINGFIELD MA
01151-1045
US

IV. Provider business mailing address

34 LIBERTY LN
ASHBURNHAM MA
01430-1436
US

V. Phone/Fax

Practice location:
  • Phone: 978-618-6946
  • Fax:
Mailing address:
  • Phone: 978-618-6946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN278694
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN278694
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN278694
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: