Provider Demographics
NPI:1083199814
Name:SUMMERS, STARLETTE ANDREA
Entity Type:Individual
Prefix:
First Name:STARLETTE
Middle Name:ANDREA
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3499 22ND ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-6152
Mailing Address - Country:US
Mailing Address - Phone:240-354-8174
Mailing Address - Fax:
Practice Address - Street 1:3322 14TH ST NW APT 325
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2365
Practice Address - Country:US
Practice Address - Phone:202-299-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC34300653747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC$$$$$$$$$Medicaid