Healthcare Provider Details

I. General information

NPI: 1821546383
Provider Name (Legal Business Name): MEADOW ROMNEY SUMMERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1064 S NORTH COUNTY BLVD
PLEASANT GROVE UT
84062-3427
US

IV. Provider business mailing address

820 N CHELAN AVE
WENATCHEE WA
98801-2028
US

V. Phone/Fax

Practice location:
  • Phone: 801-477-7189
  • Fax:
Mailing address:
  • Phone: 509-436-6906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMED-PAC-LIC-59078
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA61053866
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10077562-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: