Provider Demographics
NPI:1518390376
Name:COMFORT, GENEVIEVE TOLZDORF (PA)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:TOLZDORF
Last Name:COMFORT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:GENEVIE
Other - Middle Name:
Other - Last Name:TOLZDORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:151 MEADOWCREST ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-5256
Mailing Address - Country:US
Mailing Address - Phone:504-392-9298
Mailing Address - Fax:504-392-7047
Practice Address - Street 1:151 MEADOWCREST ST
Practice Address - Street 2:SUITE F
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5256
Practice Address - Country:US
Practice Address - Phone:504-392-9298
Practice Address - Fax:504-392-7047
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA363A00000X
LAPA.200646363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical