Provider Demographics
NPI:1144540550
Name:SOMOGYE, MARY KAREN I (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KAREN
Last Name:SOMOGYE
Suffix:I
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:KAREN
Other - Last Name:RADZINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6056 BURRWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1001
Mailing Address - Country:US
Mailing Address - Phone:419-349-0110
Mailing Address - Fax:
Practice Address - Street 1:6056 BURRWOOD DR
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-1001
Practice Address - Country:US
Practice Address - Phone:419-349-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.147510-163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3044048OtherODJFS MEDICAID
OH3044048Medicaid
OH4805205OtherDODD