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Individual
TINA SOMERVILLE
Active
Individual
TINA SOMERVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
106488
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106488
LICENSE
WV
Enumeration date
11/03/2016
Last updated
11/03/2016
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