Healthcare Provider Details

I. General information

NPI: 1750002911
Provider Name (Legal Business Name): TATUM SUMMERFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 S GLADSTONE AVE
AURORA IL
60506-4892
US

IV. Provider business mailing address

320 S COMMONWEALTH AVE
AURORA IL
60506-4846
US

V. Phone/Fax

Practice location:
  • Phone: 630-892-6431
  • Fax:
Mailing address:
  • Phone: 571-789-9804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: