Healthcare Provider Details

I. General information

NPI: 1124585302
Provider Name (Legal Business Name): DEBRA SUMMERS RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 E RICH ST
COLUMBUS OH
43215-5341
US

IV. Provider business mailing address

1273 SMOKE BURR DR
WESTERVILLE OH
43081-4509
US

V. Phone/Fax

Practice location:
  • Phone: 614-323-6533
  • Fax:
Mailing address:
  • Phone: 614-323-6533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN.271627
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: