Provider Demographics
NPI:1659809390
Name:SOMMERFELDT, DANIELLE JO (FNP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:JO
Last Name:SOMMERFELDT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N 17TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4254
Mailing Address - Country:US
Mailing Address - Phone:715-842-7707
Mailing Address - Fax:
Practice Address - Street 1:510 N 17TH AVE STE A
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4254
Practice Address - Country:US
Practice Address - Phone:715-842-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7640363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily