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General NPI Number Information
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NPI Number | 1851907836
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Entity Type | Individual
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Provider Name | JENNIFER SOMERVILLE NP
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Gender | Female
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 859 MONTAUK HWY
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City | BAYPORT
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State | NY
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Zip | 11705-1634
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Country | US
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Telephone | 631-204-3151
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Fax |
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Provider Business Mailing Address
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Address Line | 7 GLENWOOD PL
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City | FARMINGVILLE
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State | NY
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Zip | 11738-1906
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Country | US
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Telephone | 631-312-6211
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 346465
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License Number State | NY
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