Provider Demographics
NPI:1093583833
Name:SUMMERS, PATRICIA (MSN, AGPCNP-BC, APRN)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:MSN, AGPCNP-BC, APRN
Other - Prefix:
Other - First Name:PATRICIA ANN
Other - Middle Name:TIU
Other - Last Name:SAMANIEGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:PO BOX 639295 DEPT 93394
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9295
Mailing Address - Country:US
Mailing Address - Phone:248-266-4200
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:1000 BURR RIDGE PKWY STE 201
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-0864
Practice Address - Country:US
Practice Address - Phone:248-266-4200
Practice Address - Fax:855-618-6655
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.028844363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology