1164700308 NPI number — MRS. TANYA LYN SOMMERFELD M.A., L.P.

Table of content: MRS. TANYA LYN SOMMERFELD M.A., L.P. (NPI 1164700308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164700308 NPI number — MRS. TANYA LYN SOMMERFELD M.A., L.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOMMERFELD
Provider First Name:
TANYA
Provider Middle Name:
LYN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., L.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NESS
Provider Other First Name:
TANYA
Provider Other Middle Name:
LYN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164700308
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 EAST MAIN STREET
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ANOKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-201-8065
Provider Business Mailing Address Fax Number:
763-712-5588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 EAST MAIN STREET SUITE 200
Provider Second Line Business Practice Location Address:
SOUTH METRO HUMAN SERVICES
Provider Business Practice Location Address City Name:
ANOKA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-201-8065
Provider Business Practice Location Address Fax Number:
763-712-5588
Provider Enumeration Date:
07/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  LP5225 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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