Healthcare Provider Details

I. General information

NPI: 1508772815
Provider Name (Legal Business Name): SUMMER NICOLE SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 MACON POND RD STE 310
RALEIGH NC
27607-6385
US

IV. Provider business mailing address

4225 MACON POND RD STE 310
RALEIGH NC
27607-6385
US

V. Phone/Fax

Practice location:
  • Phone: 919-205-2505
  • Fax: 919-205-2595
Mailing address:
  • Phone: 919-205-2505
  • Fax: 919-205-2595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number297475
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: