Healthcare Provider Details

I. General information

NPI: 1235116153
Provider Name (Legal Business Name): SOMMER J GRANT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W DALE ST SUITE 201
WATERLOO IA
50703-1901
US

IV. Provider business mailing address

146 W DALE ST SUITE 201
WATERLOO IA
50703-1901
US

V. Phone/Fax

Practice location:
  • Phone: 319-234-4431
  • Fax: 319-235-5004
Mailing address:
  • Phone: 319-234-4431
  • Fax: 319-235-5004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number105635
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: