Provider Demographics
NPI:1699591990
Name:SOMBAH, FERGIE
Entity type:Individual
Prefix:
First Name:FERGIE
Middle Name:
Last Name:SOMBAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FIRGI
Other - Middle Name:ASTRILIA
Other - Last Name:SOPUTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:278 WHITES BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084-5236
Mailing Address - Country:US
Mailing Address - Phone:207-892-6766
Mailing Address - Fax:
Practice Address - Street 1:278 WHITES BRIDGE RD
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:ME
Practice Address - Zip Code:04084-5236
Practice Address - Country:US
Practice Address - Phone:207-892-6766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program