Provider Demographics
NPI:1164888301
Name:SUMNER, HEATHER G
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:G
Last Name:SUMNER
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 1:500 ACADEMY ST S
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3248
Mailing Address - Country:US
Mailing Address - Phone:252-287-9112
Mailing Address - Fax:252-209-3298
Practice Address - Street 1:500 ACADEMY ST S
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3248
Practice Address - Country:US
Practice Address - Phone:252-287-9112
Practice Address - Fax:252-209-3298
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001936133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered