Provider Demographics
NPI:1609037951
Name:SOMMERHAUG, KIMBERLY J (NP, MSN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:SOMMERHAUG
Suffix:
Gender:F
Credentials:NP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 ANGLERS WAY
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-7646
Mailing Address - Country:US
Mailing Address - Phone:707-766-9852
Mailing Address - Fax:707-766-1749
Practice Address - Street 1:1383 N MCDOWELL BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1187
Practice Address - Country:US
Practice Address - Phone:707-766-9852
Practice Address - Fax:707-766-1749
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504269363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily