Provider Demographics
NPI:1699234310
Name:SOMERS, ANDREA (CNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SOMERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14135 CEDAR AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-4523
Mailing Address - Country:US
Mailing Address - Phone:952-432-4373
Mailing Address - Fax:952-997-5679
Practice Address - Street 1:14135 CEDAR AVE STE 100
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4523
Practice Address - Country:US
Practice Address - Phone:952-432-4373
Practice Address - Fax:952-997-5679
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6509363LP0808X
MN201912762363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health