Healthcare Provider Details

I. General information

NPI: 1477708147
Provider Name (Legal Business Name): LISA E SOMMERHAUSER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2008
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S MERAMEC AVE
SAINT LOUIS MO
63105-1711
US

IV. Provider business mailing address

111 S MERAMEC AVE
SAINT LOUIS MO
63105-1711
US

V. Phone/Fax

Practice location:
  • Phone: 314-615-1628
  • Fax:
Mailing address:
  • Phone: 314-615-1628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number107646
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number107646
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: