Provider Demographics
NPI:1043446495
Name:DELSIGNORE, SOMER C (DNP, BC-PNP)
Entity Type:Individual
Prefix:MRS
First Name:SOMER
Middle Name:C
Last Name:DELSIGNORE
Suffix:
Gender:F
Credentials:DNP, BC-PNP
Other - Prefix:
Other - First Name:SOMER
Other - Middle Name:C
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:C-PNP
Mailing Address - Street 1:15 TRINITY WAY
Mailing Address - Street 2:
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5219
Mailing Address - Country:US
Mailing Address - Phone:845-891-6312
Mailing Address - Fax:349-559-2837
Practice Address - Street 1:291 MAIN ST
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-2899
Practice Address - Country:US
Practice Address - Phone:845-592-0727
Practice Address - Fax:346-559-2837
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006326363LP0200X
NY382024363LP0222X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03172305Medicaid
NC1043446495Medicaid
SCNP2472Medicaid
A400023330-202Medicare UPIN
SCNP2472Medicaid
NCNCE517AMedicare PIN