Healthcare Provider Details

I. General information

NPI: 1104517804
Provider Name (Legal Business Name): HAILEY BROOKE SOMMERFELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5176 HILL RD E
LAKEPORT CA
95453-6300
US

IV. Provider business mailing address

3466 GREENWOOD DR
KELSEYVILLE CA
95451-9098
US

V. Phone/Fax

Practice location:
  • Phone: 707-262-5000
  • Fax:
Mailing address:
  • Phone: 303-514-5758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95429691
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number236568
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: