Healthcare Provider Details

I. General information

NPI: 1124387550
Provider Name (Legal Business Name): KATHY SUMMERS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 US 130 N SUITE 203
CINNAMINSON NJ
08077
US

IV. Provider business mailing address

6 CATAWBA AVE
TURNERSVILLE NJ
08012-1646
US

V. Phone/Fax

Practice location:
  • Phone: 856-829-9345
  • Fax:
Mailing address:
  • Phone: 856-313-5121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NO08448700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: