Provider Demographics
NPI:1891142766
Name:COMEAU, PATRICIA LYNN
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LYNN
Last Name:COMEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 DUFFERN DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-4332
Mailing Address - Country:US
Mailing Address - Phone:585-698-5146
Mailing Address - Fax:
Practice Address - Street 1:163 DUFFERN DRIVE 163 DUFFERN DRIVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-4332
Practice Address - Country:US
Practice Address - Phone:585-698-5146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316831164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04497018Medicaid
NY316831Medicaid