Provider Demographics
NPI:1881925394
Name:MATHELIER, COMFORT CAINE (LPN)
Entity type:Individual
Prefix:MRS
First Name:COMFORT
Middle Name:CAINE
Last Name:MATHELIER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SUMMIT AVE
Mailing Address - Street 2:APT 206N
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-5384
Mailing Address - Country:US
Mailing Address - Phone:845-352-0931
Mailing Address - Fax:
Practice Address - Street 1:9 SUMMIT AVE
Practice Address - Street 2:APT 206N
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5384
Practice Address - Country:US
Practice Address - Phone:845-352-0931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264056164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY264056OtherLICENSED PRACTICAL NURSE