Provider Demographics
NPI:1588022396
Name:COMEAUX, ALISA
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:COMEAUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:ANN
Other - Last Name:HAYNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-6052
Mailing Address - Country:US
Mailing Address - Phone:318-357-3122
Mailing Address - Fax:
Practice Address - Street 1:210 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6052
Practice Address - Country:US
Practice Address - Phone:318-357-3122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist