Healthcare Provider Details

I. General information

NPI: 1699005504
Provider Name (Legal Business Name): SUMMER DUNCAN TEMPLETON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. SUMMER DAWN DUNCAN

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1757 IMPERIAL BLVD.
LAKE CHARLES LA
70605
US

IV. Provider business mailing address

13523 BARRETT PARKWAY DRIVE SUITE 104
BALLWIN MO
63102
US

V. Phone/Fax

Practice location:
  • Phone: 337-310-2832
  • Fax:
Mailing address:
  • Phone: 636-938-6868
  • Fax: 636-938-1486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number714011
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: