Provider Demographics
NPI:1386644615
Name:COMEAU, PERRY J (CRNA)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:J
Last Name:COMEAU
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4552
Mailing Address - Country:US
Mailing Address - Phone:952-442-9770
Mailing Address - Fax:952-442-3620
Practice Address - Street 1:201 8TH AVE SE
Practice Address - Street 2:
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-2447
Practice Address - Country:US
Practice Address - Phone:319-283-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA105345367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
186421OtherCOVENTRY/HC/HC PREFERRED
IA0426569Medicaid
IA35852OtherBLUE CROSS OF IA
05451OtherIA BCCEDP
IAI10852Medicare ID - Type Unspecified
186421OtherCOVENTRY/HC/HC PREFERRED