MEDICARE: LORENA MICHELLE SUMNER-NASSIF PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA10747	TX

General Provider Information

NPI Number	:	1043761455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORENA MICHELLE SUMNER-NASSIF PA-C

Provider Business Mailing Address
First Line	:	10407 W FAIRMONT PKWY
Second Line	:
City	:	LA PORTE
State	:	TX
Zip	:	77571-6017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9809 ROWLETT RD # A1
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77075-3438
Country	:	US
Telephone Number	:	713-644-1119
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2016
Last Update Date	:	01/15/2020

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