Healthcare Provider Details

I. General information

NPI: 1891137519
Provider Name (Legal Business Name): JANET EILEEN SOMERVILLE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3558 KLINE RD
ROOTSTOWN OH
44272-9645
US

IV. Provider business mailing address

3558 KLINE RD
ROOTSTOWN OH
44272-9645
US

V. Phone/Fax

Practice location:
  • Phone: 330-850-5022
  • Fax:
Mailing address:
  • Phone: 330-850-5022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN137062-M-IV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: