Provider Demographics
NPI:1346760188
Name:COMER, SHIRLEY KATHLEEN (ACNS-BC, APN)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:KATHLEEN
Last Name:COMER
Suffix:
Gender:F
Credentials:ACNS-BC, APN
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Mailing Address - Street 1:1745 N INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-1105
Mailing Address - Country:US
Mailing Address - Phone:219-789-6649
Mailing Address - Fax:708-235-2197
Practice Address - Street 1:606 E COURT ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-4011
Practice Address - Country:US
Practice Address - Phone:815-216-3346
Practice Address - Fax:815-348-6701
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.016069207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine