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General NPI Number Information
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NPI Number | 1881223766
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Entity Type | Individual
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Provider Name | MRS. LISA JEAN SOMERVILLE
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Gender | Female
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Dates
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Enumeration Date | 04/03/2020
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Last Update Date | 04/03/2020
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Provider Practice Location Address
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Address Line | 2900 CURVE CREST BLVD W
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City | STILLWATER
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State | MN
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Zip | 55082-5085
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Country | US
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Telephone | 651-471-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 1122 1ST ST
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City | HUDSON
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State | WI
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Zip | 54016-1205
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Country | US
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Telephone | 715-245-0965
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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 | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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