Healthcare Provider Details

I. General information

NPI: 1003303165
Provider Name (Legal Business Name): SUMMER MORGAN MASSINA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2018
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 NW 9TH AVE STE 100
PORTLAND OR
97209-3519
US

IV. Provider business mailing address

2710 SAINT FRANCIS DR
WATERLOO IA
50702-5619
US

V. Phone/Fax

Practice location:
  • Phone: 503-525-0090
  • Fax:
Mailing address:
  • Phone: 319-272-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA134262
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202213854NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: