Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 76567 | WI |
NPI | 1013476381 |
---|---|
Provider Name | Jeanette Rae Comstock |
First Address | Madison, WI 53792-0001 |
Second Address | Madison, WI 53792-4329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2019 |
Last Update Date | 04/01/2022 |