Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 29167 | SC |
N | 207Q00000X | Family Doctor | 38512 | IA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 54768 | WI |
NPI | 1740473651 |
---|---|
Provider Name | Dr. Amanda Charity Sommerfeldt |
First Address | De Pere, WI 54115-9207 |
Second Address | De Pere, WI 54115-9207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2007 |
Last Update Date | 22/03/2011 |