Provider Demographics
NPI:1093480212
Name:SUMMERS, CARLA DIANE
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:DIANE
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 1:1603 16TH ST APT C
Mailing Address - Street 2:
Mailing Address - City:NITRO
Mailing Address - State:WV
Mailing Address - Zip Code:25143-1807
Mailing Address - Country:US
Mailing Address - Phone:304-741-5672
Mailing Address - Fax:
Practice Address - Street 1:1603 16TH ST APT C
Practice Address - Street 2:
Practice Address - City:NITRO
Practice Address - State:WV
Practice Address - Zip Code:25143-1807
Practice Address - Country:US
Practice Address - Phone:304-741-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant