Provider Demographics
NPI:1922290766
Name:SOMMERS, STACY MICHELLE (RN)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:MICHELLE
Last Name:SOMMERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 N MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2515
Mailing Address - Country:US
Mailing Address - Phone:740-701-0345
Mailing Address - Fax:
Practice Address - Street 1:140 N MULBERRY ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2515
Practice Address - Country:US
Practice Address - Phone:740-701-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH323742163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse