=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588005409
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIM MICHELE SUMMERS CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2013
-----------------------------------------------------
Last Update Date | 07/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 LAKESIDE AVE E SUITE 1000
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44114-1158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-308-1793
-----------------------------------------------------
Fax | 855-569-4705
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 704
-----------------------------------------------------
City | BRUNSWICK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44212-0704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-606-7296
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 24733
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------