Provider Demographics
NPI:1659035327
Name:COMER, KATRINA MAE
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:MAE
Last Name:COMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:MAE
Other - Last Name:ARMEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-3608
Mailing Address - Country:US
Mailing Address - Phone:701-381-0060
Mailing Address - Fax:
Practice Address - Street 1:7887 MISSION ROAD
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:ND
Practice Address - Zip Code:58370
Practice Address - Country:US
Practice Address - Phone:701-381-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant