Provider Demographics
NPI:1235116153
Name:GRANT, SOMMER J (ARNP)
Entity Type:Individual
Prefix:
First Name:SOMMER
Middle Name:J
Last Name:GRANT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 W DALE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-1901
Mailing Address - Country:US
Mailing Address - Phone:319-234-4431
Mailing Address - Fax:319-235-5004
Practice Address - Street 1:146 W DALE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1901
Practice Address - Country:US
Practice Address - Phone:319-234-4431
Practice Address - Fax:319-235-5004
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA105635363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00751284OtherRR MEDICARE
IAP00751284OtherRR MEDICARE
IAI14562Medicare ID - Type Unspecified