Basic Information
| Provider Information | |||||||||
| NPI: | 1730155631 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COMEAU | ||||||||
| FirstName: | GAYLE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7115 CADE RD | ||||||||
| Address2: | |||||||||
| City: | BROWN CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484169778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103462757 | ||||||||
| FaxNumber: | 8103462016 | ||||||||
| Practice Location | |||||||||
| Address1: | 7115 CADE RD | ||||||||
| Address2: | |||||||||
| City: | BROWN CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484169778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103462757 | ||||||||
| FaxNumber: | 8103462016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 11/06/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4704144208 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | GB144208 | 01 | MI | BLUE CROSS BLUE SHIELD OF MICHIGAN | OTHER |