MEDICARE: PATRICIA KATHERINE SUMMERS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP1459	AZ

General Provider Information

NPI Number	:	1710949805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA KATHERINE SUMMERS FNP-C

Provider Business Mailing Address
First Line	:	3003 N CENTRAL AVE
Second Line	:	STE 800
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2902
Country	:	US
Telephone Number	:	602-319-4623
Fax Number	:	602-462-1132

Provider Business Practice Location Address
First Line	:	3003 N CENTRAL AVE
Second Line	:	STE 800
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2902
Country	:	US
Telephone Number	:	602-319-4623
Fax Number	:	602-462-1132

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	04/28/2015

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