Provider Demographics
NPI:1003822776
Name:SUMMERFIELD, ALAN K (APRN, CRNA)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:K
Last Name:SUMMERFIELD
Suffix:
Gender:M
Credentials:APRN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 WASHINGTON BLVD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-2216
Mailing Address - Country:US
Mailing Address - Phone:203-348-2614
Mailing Address - Fax:203-325-8677
Practice Address - Street 1:1055 WASHINGTON BLVD
Practice Address - Street 2:SUITE 440
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-2216
Practice Address - Country:US
Practice Address - Phone:203-348-2614
Practice Address - Fax:203-325-8677
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001123367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004213766Medicaid
CT004213766Medicaid