Provider Demographics
NPI:1407459043
Name:WOMACK, SOMMER JERMENE
Entity Type:Individual
Prefix:
First Name:SOMMER
Middle Name:JERMENE
Last Name:WOMACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2992 MEGAN CIR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-4388
Mailing Address - Country:US
Mailing Address - Phone:330-716-7969
Mailing Address - Fax:
Practice Address - Street 1:2992 MEGAN CIR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-4388
Practice Address - Country:US
Practice Address - Phone:330-716-7969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0364272374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide