Basic Information
| Provider Information | |||||||||
| NPI: | 1518384700 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE NEURO MONITORING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4570 AVERY LN SE STE C-10 | ||||||||
| Address2: | |||||||||
| City: | LACEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985035608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807551921 | ||||||||
| FaxNumber: | 3609253470 | ||||||||
| Practice Location | |||||||||
| Address1: | 45211 HELM ST | ||||||||
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| City: | PLYMOUTH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481706023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345259712 | ||||||||
| FaxNumber: | 7342454092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2014 | ||||||||
| LastUpdateDate: | 07/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | FANELLI | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF CLINICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4807551921 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | N | Laboratories | Clinical Medical Laboratory | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.