MEDICARE: LAYNE T SUMMERS

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	367500000X	Certified Registered Nurse Anesthetist	342852-4406	UT

General Provider Information

NPI Number	:	1528087848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAYNE T SUMMERS

Provider Business Mailing Address
First Line	:	12420 W FAUST VALLEY RD
Second Line	:
City	:	TREMONTON
State	:	UT
Zip	:	84337-9003
Country	:	US
Telephone Number	:	435-452-1331
Fax Number	:

Provider Business Practice Location Address
First Line	:	905 N 1000 W
Second Line	:
City	:	TREMONTON
State	:	UT
Zip	:	84337-9356
Country	:	US
Telephone Number	:	435-207-4600
Fax Number	:

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	08/17/2018

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Directions to “ LAYNE T SUMMERS ” Practice Location

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