Provider Demographics
NPI:1609861434
Name:SOMERS, ANN ELIZABETH (MSN)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:ELIZABETH
Last Name:SOMERS
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:WHITCOMB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN
Mailing Address - Street 1:3700 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3700 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2144
Practice Address - Country:US
Practice Address - Phone:866-825-3227
Practice Address - Fax:866-825-3227
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1025482363LF0000X
WI3043-033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN004266800Medicaid
500002920Medicare ID - Type Unspecified
Q36161Medicare UPIN