Provider Demographics
NPI:1508094194
Name:KOMMER, CAROLE L (RN)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:L
Last Name:KOMMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:COOKIE
Other - Middle Name:
Other - Last Name:KOMMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1275 BEAL ROAD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-9218
Mailing Address - Country:US
Mailing Address - Phone:419-989-8906
Mailing Address - Fax:419-529-9793
Practice Address - Street 1:1275 BEAL ROAD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-9218
Practice Address - Country:US
Practice Address - Phone:419-989-8906
Practice Address - Fax:419-529-9793
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH107200093163WH1000X
OHRN. 259899163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH1000XNursing Service ProvidersRegistered NurseHospice