Provider Demographics
NPI:1073803144
Name:MOWRY, SUMMER D (NP)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:D
Last Name:MOWRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-0911
Mailing Address - Country:US
Mailing Address - Phone:207-396-7601
Mailing Address - Fax:207-396-8381
Practice Address - Street 1:100 CAMPUS DR
Practice Address - Street 2:SUITE 108
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7171
Practice Address - Country:US
Practice Address - Phone:207-396-7600
Practice Address - Fax:207-396-7610
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR200997-3363L00000X
MECNP131126363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEENROLLEDMedicaid
MNENROLLEDMedicaid
MNENROLLEDMedicaid
MN500006717Medicare PIN