Healthcare Provider Details

I. General information

NPI: 1144352097
Provider Name (Legal Business Name): BETTY M SUMMER CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 10/15/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSA HOSPICE 2228 HARRINGTON SR
NEWBERRY SC
29108
US

IV. Provider business mailing address

308 NELL ST
BATESBURG LEESVILLE SC
29006-2621
US

V. Phone/Fax

Practice location:
  • Phone: 803-321-0341
  • Fax: 803-321-0517
Mailing address:
  • Phone: 180-331-5839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN 2412
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: