Provider Demographics
NPI:1043349053
Name:SUMMERS, JORDANA BLUE (LMP)
Entity Type:Individual
Prefix:
First Name:JORDANA
Middle Name:BLUE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:JORDANA
Other - Middle Name:BLUE
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:7309 SAND POINT WAY NE UNIT 730
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6850 35TH AVE NE STE 11
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-7344
Practice Address - Country:US
Practice Address - Phone:206-852-8901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018927174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist