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NPI Code Detail

MEDICARE: NETHRA SOMANNAGARI

MEDICARE: NETHRA SOMANNAGARI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramRL24428ND

General Provider Information

NPI Number : 1124951447
Entity Type Code : Individual
Provider Name (Legal Business Name) : NETHRA SOMANNAGARI
Provider Business Mailing Address
First Line : 1505 BALSAM LN
Second Line :
City : WOODRIDGE
State : IL
Zip : 60517-4643
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5225 23RD AVE S
Second Line :
City : FARGO
State : ND
Zip : 58104-7927
Country : US
Telephone Number : 701-234-5933
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2026
Last Update Date : 06/05/2026

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Directions to “ NETHRA SOMANNAGARI ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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