Healthcare Provider Details

I. General information

NPI: 1114631900
Provider Name (Legal Business Name): MEGAN EILEEN SOMMER BSN, RN, CCRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MARK WEST SPRINGS RD
SANTA ROSA CA
95403-1436
US

IV. Provider business mailing address

11 PERSIMMON CT
PETALUMA CA
94954-4625
US

V. Phone/Fax

Practice location:
  • Phone: 707-576-4500
  • Fax:
Mailing address:
  • Phone: 510-456-8869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95096318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: