Healthcare Provider Details

I. General information

NPI: 1700535341
Provider Name (Legal Business Name): SUMMER IKENOUYE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 04/16/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13585 QUEBEC ST
THORNTON CO
80602
US

IV. Provider business mailing address

2901 PURCELL ST
BRIGHTON CO
80601-3550
US

V. Phone/Fax

Practice location:
  • Phone: 720-583-2105
  • Fax:
Mailing address:
  • Phone: 303-659-9700
  • Fax: 720-336-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN.0182230
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: