Provider Demographics
NPI:1891137519
Name:SOMERVILLE, JANET EILEEN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:EILEEN
Last Name:SOMERVILLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3558 KLINE RD
Mailing Address - Street 2:
Mailing Address - City:ROOTSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44272-9645
Mailing Address - Country:US
Mailing Address - Phone:330-850-5022
Mailing Address - Fax:
Practice Address - Street 1:3558 KLINE RD
Practice Address - Street 2:
Practice Address - City:ROOTSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44272-9645
Practice Address - Country:US
Practice Address - Phone:330-850-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN137062-M-IV164W00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide