Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CH 7371 | FL |
NPI | 1003913898 |
---|---|
Provider Name | Dr. Laurie Annette Somerville |
First Address | Fargo, ND 58103-4940 |
Second Address | Fargo, ND 58103-4940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 13/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3815650-00 | (05) | FL |
55724Z | MEDICARE PTAN (01) | FL |
U90193 | (02) | FL |