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General NPI Number Information
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NPI Number | 1891990701
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Entity Type | Individual
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Provider Name | MEGHAN MARIE SUMMEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 1925 BRETON RD SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-4810
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Country | US
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Telephone | 616-252-4100
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Fax | 616-252-4953
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Provider Business Mailing Address
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Address Line | 985 GEZON PKWY SW ATTN: TERESA MCNALLY
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City | WYOMING
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State | MI
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Zip | 49509-9563
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Country | US
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Telephone | 616-252-4655
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Fax | 616-252-0103
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601005000
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License Number State | MI
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