=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336285477
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HELINA SOMERVELL CRNP, FAANP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2007
-----------------------------------------------------
Last Update Date | 12/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 CENTER DR RM 4-5940
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20892-0004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-858-3477
-----------------------------------------------------
Fax | 301-402-1788
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 CENTER DR RM 4-5940
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20892-0004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-858-3477
-----------------------------------------------------
Fax | 301-402-1788
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | R117393
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------