Healthcare Provider Details

I. General information

NPI: 1851810055
Provider Name (Legal Business Name): DANIELL M SUMMERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 01/29/2021
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N WEST ST
ODON IN
47562-1032
US

IV. Provider business mailing address

12546 E US HIGHWAY 50
LOOGOOTEE IN
47553-5220
US

V. Phone/Fax

Practice location:
  • Phone: 812-636-7300
  • Fax:
Mailing address:
  • Phone: 812-295-5095
  • Fax: 812-295-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28196995A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: