Healthcare Provider Details

I. General information

NPI: 1770950149
Provider Name (Legal Business Name): MARY SUMMA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MOOSIC ST
SCRANTON PA
18505-2105
US

IV. Provider business mailing address

1117 1/2 W LOCUST ST
SCRANTON PA
18504-2105
US

V. Phone/Fax

Practice location:
  • Phone: 570-347-6991
  • Fax:
Mailing address:
  • Phone: 570-445-8731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015209
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: