Healthcare Provider Details

I. General information

NPI: 1467658559
Provider Name (Legal Business Name): TERESE MARIE SOMMERFELD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S PAULINA ST
CHICAGO IL
60612-3808
US

IV. Provider business mailing address

1340 BURNHAM LN
BATAVIA IL
60510-8670
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-8241
  • Fax: 312-942-3601
Mailing address:
  • Phone: 630-406-5733
  • Fax: 630-406-0481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: