Provider Demographics
NPI:1144424300
Name:SOMMERS, ANNJANETTE (PA C)
Entity Type:Individual
Prefix:MRS
First Name:ANNJANETTE
Middle Name:
Last Name:SOMMERS
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:ANNJANETTE
Other - Middle Name:
Other - Last Name:STODDARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1163 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-5014
Mailing Address - Country:US
Mailing Address - Phone:503-329-5949
Mailing Address - Fax:
Practice Address - Street 1:222 SE 8TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4218
Practice Address - Country:US
Practice Address - Phone:503-352-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLL14784363A00000X
ORPA01026363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant