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General NPI Number Information
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NPI Number | 1518384700
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE NEURO MONITORING, LLC
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 45211 HELM ST
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City | PLYMOUTH
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State | MI
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Zip | 48170-6023
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Country | US
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Telephone | 734-525-9712
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Fax | 734-245-4092
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Provider Business Mailing Address
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Address Line | 4570 AVERY LN SE STE C-10
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City | LACEY
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State | WA
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Zip | 98503-5608
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Country | US
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Telephone | 480-755-1921
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Fax | 360-925-3470
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Authorized Official
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Title or Position | CHIEF CLINICAL OFFICER
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Name | PATRICIA FANELLI
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Credential |
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Telephone | 480-755-1921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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