Healthcare Provider Details

I. General information

NPI: 1528498045
Provider Name (Legal Business Name): SANDRA SUMMERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 KENDALL DR
LAMAR CO
81052-3939
US

IV. Provider business mailing address

201 KENDALL DR
LAMAR CO
81052-3939
US

V. Phone/Fax

Practice location:
  • Phone: 719-336-0261
  • Fax: 719-336-0265
Mailing address:
  • Phone: 719-336-0261
  • Fax: 719-336-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0002947
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: