Provider Demographics
NPI:1225471287
Name:SOMMERVILLE, TAMIKA MONIK (LPN NURSE)
Entity Type:Individual
Prefix:MS
First Name:TAMIKA
Middle Name:MONIK
Last Name:SOMMERVILLE
Suffix:
Gender:F
Credentials:LPN NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 ALMA AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3218
Mailing Address - Country:US
Mailing Address - Phone:716-605-7752
Mailing Address - Fax:
Practice Address - Street 1:78 ALMA AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3218
Practice Address - Country:US
Practice Address - Phone:716-605-7752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306218-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse