Individual
DR. LAURIE ANNETTE SOMERVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1720 UNIVERSITY DR S, FARGO, ND 58103-4940
(701) 280-4140
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
CH 7371
FL
363A00000X
Physician Assistant
PA9108339
FL
363A00000X
Physician Assistant
Primary
PAC0699
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3815650-00
—
FL
01
—
55724Z
MEDICARE PTAN
FL
Enumeration date
09/20/2006
Last updated
10/29/2024
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