Provider Demographics
NPI:1417286733
Name:SOMMERS, JENNA (LMT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:SOMMERS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7756 BLUEBERRY HILL LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-7911
Mailing Address - Country:US
Mailing Address - Phone:410-917-7616
Mailing Address - Fax:
Practice Address - Street 1:7756 BLUEBERRY HILL LN
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-7911
Practice Address - Country:US
Practice Address - Phone:410-917-7616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02050171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist