Healthcare Provider Details

I. General information

NPI: 1114295961
Provider Name (Legal Business Name): SARA MICHELLE SOMMA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 EXETER RD SUITE 210
GERMANTOWN TN
38138-2954
US

IV. Provider business mailing address

1900 EXETER RD SUITE 210
GERMANTOWN TN
38138-2954
US

V. Phone/Fax

Practice location:
  • Phone: 901-818-2183
  • Fax:
Mailing address:
  • Phone: 901-818-2183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN0000156372
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number16388
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: