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General NPI Number Information
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NPI Number | 1063389864
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Entity Type | Organization
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Legal Business Name | SUMMER BREEZE MENOPAUSE & HORMONE CARE LLC
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Dates
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Enumeration Date | 10/17/2025
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 1815 FAWN WAY
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City | FINKSBURG
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State | MD
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Zip | 21048-2020
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Country | US
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Telephone | 443-205-6356
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Fax |
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Provider Business Mailing Address
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Address Line | 1815 FAWN WAY
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City | FINKSBURG
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State | MD
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Zip | 21048-2020
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Country | US
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Telephone | 443-205-6356
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | SUMMER MCKISSICK
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Credential | MSN, CRNP, A-GNP-C
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Telephone | 443-205-6356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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