Healthcare Provider Details

I. General information

NPI: 1629499058
Provider Name (Legal Business Name): RENEE SOMMERS-BEAGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE SOMMERS

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 S CREASY LN
LAFAYETTE IN
47905-4972
US

IV. Provider business mailing address

250 W 96TH ST STE 520
INDIANAPOLIS IN
46260-1317
US

V. Phone/Fax

Practice location:
  • Phone: 765-502-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704261116
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number4704261116
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number71017566A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: