Provider Demographics
NPI:1245605534
Name:COMERCI, NELSON (LAC)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:COMERCI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-0147
Mailing Address - Country:US
Mailing Address - Phone:208-946-8075
Mailing Address - Fax:
Practice Address - Street 1:7571 SHOSHONE LANE
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-0147
Practice Address - Country:US
Practice Address - Phone:208-946-8075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACU-288171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist