Provider Demographics
NPI:1811093115
Name:CALVILLO SOMMERFELDT, ELIZABETH JULIA (PA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JULIA
Last Name:CALVILLO SOMMERFELDT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2163 NW 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-9108
Mailing Address - Country:US
Mailing Address - Phone:503-472-4197
Mailing Address - Fax:503-434-2886
Practice Address - Street 1:2163 NW 2ND STREET
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-9108
Practice Address - Country:US
Practice Address - Phone:503-472-4197
Practice Address - Fax:503-434-2886
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR056221Medicaid
Q32676Medicare UPIN
OR056221Medicaid