Provider Demographics
NPI:1437400587
Name:COMER, CELINA JO (APRN-CNP)
Entity type:Individual
Prefix:
First Name:CELINA
Middle Name:JO
Last Name:COMER
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:425 N MICHIGAN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BEULAH
Mailing Address - State:MI
Mailing Address - Zip Code:49617-9560
Mailing Address - Country:US
Mailing Address - Phone:231-882-6186
Mailing Address - Fax:231-399-0311
Practice Address - Street 1:425 N MICHIGAN AVE STE B
Practice Address - Street 2:
Practice Address - City:BEULAH
Practice Address - State:MI
Practice Address - Zip Code:49617-9560
Practice Address - Country:US
Practice Address - Phone:231-882-6186
Practice Address - Fax:231-399-0311
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704297987363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1437400587Medicaid