Provider Demographics
NPI:1912308586
Name:COMER, GLORIA ANTOINETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:ANTOINETTE
Last Name:COMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 LANGTREE LN
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-9190
Mailing Address - Country:US
Mailing Address - Phone:937-474-1756
Mailing Address - Fax:
Practice Address - Street 1:2670 LANGTREE LN
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-9190
Practice Address - Country:US
Practice Address - Phone:937-474-1756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-14
Last Update Date:2014-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-290988163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse