Healthcare Provider Details

I. General information

NPI: 1841775590
Provider Name (Legal Business Name): GINA MARIE SOMMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E HIGHWAY 30
MAXWELL NE
69151-1132
US

IV. Provider business mailing address

PO BOX 28
MAXWELL NE
69151-0028
US

V. Phone/Fax

Practice location:
  • Phone: 308-582-4585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number54962
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: