Healthcare Provider Details

I. General information

NPI: 1588464952
Provider Name (Legal Business Name): SUMMER HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2025
Last Update Date: 03/15/2025
Certification Date: 03/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 WENDELL BLVD
WENDELL NC
27591-6831
US

IV. Provider business mailing address

1500 ANNALOU WAY
WENDELL NC
27591-9855
US

V. Phone/Fax

Practice location:
  • Phone: 919-356-8484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number317129
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: