Healthcare Provider Details

I. General information

NPI: 1518403716
Provider Name (Legal Business Name): ASHLEIGH SOMMER AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W CARPENTER ST FL 2
SPRINGFIELD IL
62702-4901
US

IV. Provider business mailing address

315 W CARPENTER ST
SPRINGFIELD IL
62702-4901
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-7053
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-7053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209015387
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: