Provider Demographics
NPI:1154636207
Name:MACK, SUMMER ANN (CHA II)
Entity Type:Individual
Prefix:MS
First Name:SUMMER
Middle Name:ANN
Last Name:MACK
Suffix:
Gender:F
Credentials:CHA II
Other - Prefix:MRS
Other - First Name:SUMMER
Other - Middle Name:ANN
Other - Last Name:DRAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3380 C ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3949
Mailing Address - Country:US
Mailing Address - Phone:907-497-2311
Mailing Address - Fax:907-497-2310
Practice Address - Street 1:100 SLOCUM DRIVE
Practice Address - Street 2:
Practice Address - City:KING COVE
Practice Address - State:AK
Practice Address - Zip Code:99612
Practice Address - Country:US
Practice Address - Phone:907-497-2311
Practice Address - Fax:907-497-2310
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCL9107Medicaid