Provider Demographics
NPI:1124585302
Name:SUMMERS, DEBRA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 SMOKE BURR DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4509
Mailing Address - Country:US
Mailing Address - Phone:614-323-6533
Mailing Address - Fax:
Practice Address - Street 1:604 E RICH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5341
Practice Address - Country:US
Practice Address - Phone:614-323-6533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.271627163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant