Provider Demographics
NPI:1851460067
Name:SOMMERS, JOAN (CDF)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:SOMMERS
Suffix:
Gender:F
Credentials:CDF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SALEM TURNPIKE
Mailing Address - Street 2:BACKUS OUTPATIENT CARE CENTER
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:860-889-8331
Mailing Address - Fax:
Practice Address - Street 1:111 SALEM TURNPIKE
Practice Address - Street 2:BACKUS OUTPATIENT CARE CENTER
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-889-8331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000541133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered