Provider Demographics
NPI:1023563624
Name:COMER, MEREDITH (LPN, CLC)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:COMER
Suffix:
Gender:F
Credentials:LPN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 L AND L RD
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-8821
Mailing Address - Country:US
Mailing Address - Phone:336-469-7357
Mailing Address - Fax:
Practice Address - Street 1:239 L AND L RD
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-8821
Practice Address - Country:US
Practice Address - Phone:336-469-7357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC58276164W00000X
174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No164W00000XNursing Service ProvidersLicensed Practical Nurse