Provider Demographics
NPI:1003303165
Name:MASSINA, SUMMER MORGAN (ARNP)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:MORGAN
Last Name:MASSINA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 SAINT FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5619
Mailing Address - Country:US
Mailing Address - Phone:319-272-5000
Mailing Address - Fax:
Practice Address - Street 1:721 NW 9TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3519
Practice Address - Country:US
Practice Address - Phone:503-525-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-15
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA134262363L00000X
OR202213854NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner