Provider Demographics
NPI:1255695912
Name:COMEAU, ANTONETTE M (NP)
Entity type:Individual
Prefix:
First Name:ANTONETTE
Middle Name:M
Last Name:COMEAU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:ASHBURNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01430-1436
Mailing Address - Country:US
Mailing Address - Phone:978-618-6946
Mailing Address - Fax:
Practice Address - Street 1:819 WORCESTER ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01151-1045
Practice Address - Country:US
Practice Address - Phone:978-618-6946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN278694363L00000X, 363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology