MEDICARE: BRENT SOMMER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	CRNA1000	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447270145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT SOMMER CRNA

Provider Business Mailing Address
First Line	:	1348 NOE ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94131-1923
Country	:	US
Telephone Number	:	415-642-1170
Fax Number	:	415-642-1170

Provider Business Practice Location Address
First Line	:	1348 NOE ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94131-1923
Country	:	US
Telephone Number	:	415-642-1170
Fax Number	:	415-642-1171

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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Directions to “ BRENT SOMMER CRNA” Practice Location

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