Provider Demographics
NPI:1720650146
Name:SOMMERS, MEGAN N (APRN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:N
Last Name:SOMMERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:NICHOLE
Other - Last Name:MANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4721 GASTON CIR
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53527-9765
Mailing Address - Country:US
Mailing Address - Phone:608-213-9736
Mailing Address - Fax:
Practice Address - Street 1:1000 MINERAL POINT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2940
Practice Address - Country:US
Practice Address - Phone:608-756-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1046333363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner