Healthcare Provider Details

I. General information

NPI: 1134485329
Provider Name (Legal Business Name): SUMMER ALIA BLAIR ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 LINDA ST SUITE 103
ROCKY RIVER OH
44116-1853
US

IV. Provider business mailing address

20 S 3RD ST STE 210
COLUMBUS OH
43215-4206
US

V. Phone/Fax

Practice location:
  • Phone: 440-250-3560
  • Fax: 216-712-7066
Mailing address:
  • Phone: 833-445-5998
  • Fax: 844-249-5579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number13164
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: