Healthcare Provider Details

I. General information

NPI: 1073824926
Provider Name (Legal Business Name): MARY SOMMERS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 ROOSEVELT RD
BERWYN IL
60402-1108
US

IV. Provider business mailing address

6201 ROOSEVELT RD
BERWYN IL
60402-1108
US

V. Phone/Fax

Practice location:
  • Phone: 708-386-0845
  • Fax: 83-868-4727
Mailing address:
  • Phone: 708-386-0845
  • Fax: 83-868-4727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: