Provider Demographics
NPI:1295068765
Name:SOMMERS, SUSAN JILL (CNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JILL
Last Name:SOMMERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:SOMMERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:2818 S ARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-4716
Mailing Address - Country:US
Mailing Address - Phone:330-645-0148
Mailing Address - Fax:330-645-1524
Practice Address - Street 1:2818 S ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-4716
Practice Address - Country:US
Practice Address - Phone:330-645-0148
Practice Address - Fax:330-645-1524
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA10781NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH3045627Medicaid
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #