Provider Demographics
NPI:1043369036
Name:COMSTOCK, JOHNNIE LEE NORA
Entity type:Individual
Prefix:MRS
First Name:JOHNNIE
Middle Name:LEE NORA
Last Name:COMSTOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 BURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-5208
Mailing Address - Country:US
Mailing Address - Phone:325-944-0962
Mailing Address - Fax:
Practice Address - Street 1:313 BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-5208
Practice Address - Country:US
Practice Address - Phone:325-944-0962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies