Provider Demographics
NPI:1518384700
Name:COMPREHENSIVE NEURO MONITORING, LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE NEURO MONITORING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-755-1921
Mailing Address - Street 1:4570 AVERY LN SE STE C-10
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5608
Mailing Address - Country:US
Mailing Address - Phone:480-755-1921
Mailing Address - Fax:360-925-3470
Practice Address - Street 1:45211 HELM ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-6023
Practice Address - Country:US
Practice Address - Phone:734-525-9712
Practice Address - Fax:734-245-4092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-25
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty