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General NPI Number Information
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NPI Number | 1649314840
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Entity Type | Individual
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Provider Name | MRS. MARY JONES SOMERVILLE
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Gender | Female
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 303 W FRANKLIN ST
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City | WARRENTON
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State | NC
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Zip | 27589-1937
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Country | US
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Telephone | 252-257-4568
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Fax | 252-257-2388
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Provider Business Mailing Address
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Address Line | 686 AXTELL RIDGEWAY RD
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City | NORLINA
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State | NC
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Zip | 27563-9250
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Country | US
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Telephone | 252-456-4239
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Fax | 252-456-3718
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number | 715493
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License Number State | NC
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