Provider Demographics
NPI:1548022957
Name:BOMMER, HALLIE
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:
Last Name:BOMMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52524 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BEALLSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43716-9306
Mailing Address - Country:US
Mailing Address - Phone:740-310-2581
Mailing Address - Fax:
Practice Address - Street 1:52524 BROAD ST
Practice Address - Street 2:
Practice Address - City:BEALLSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43716-9306
Practice Address - Country:US
Practice Address - Phone:740-310-2581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker