Healthcare Provider Details

I. General information

NPI: 1023004066
Provider Name (Legal Business Name): DEBORAH JEAN SOMMERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 US HIGHWAY 20
WAKEMAN OH
44889-9110
US

IV. Provider business mailing address

472 US HIGHWAY 20
WAKEMAN OH
44889-9110
US

V. Phone/Fax

Practice location:
  • Phone: 440-839-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.000956RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: