Basic Information
| Provider Information | |||||||||
| NPI: | 1386644615 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COMEAU | ||||||||
| FirstName: | PERRY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 E 10TH ST | ||||||||
| Address2: | |||||||||
| City: | WACONIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553874552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524429770 | ||||||||
| FaxNumber: | 9524423620 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 8TH AVE SE | ||||||||
| Address2: | |||||||||
| City: | OELWEIN | ||||||||
| State: | IA | ||||||||
| PostalCode: | 506622447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192836000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 04/29/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 105345 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 186421 | 01 | COVENTRY/HC/HC PREFERRED | OTHER | 0426569 | 05 | IA | MEDICAID | 35852 | 01 | IA | BLUE CROSS OF IA | OTHER | 05451 | 01 | IA BCCEDP | OTHER |