Healthcare Provider Details

I. General information

NPI: 1679491591
Provider Name (Legal Business Name): SUMMER GILLESPIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 MILITARY TPKE
PLATTSBURGH NY
12901
US

IV. Provider business mailing address

1697 HARDSCRABBLE RD
SARANAC NY
12981-3735
US

V. Phone/Fax

Practice location:
  • Phone: 518-561-0100
  • Fax:
Mailing address:
  • Phone: 518-572-4415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number825396-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: