Provider Demographics
NPI:1225465917
Name:SEELY, SUMMERS D (RNFA)
Entity Type:Individual
Prefix:
First Name:SUMMERS
Middle Name:D
Last Name:SEELY
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:SUMMERS
Other - Middle Name:
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1341 NW LAWNRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1217
Mailing Address - Country:US
Mailing Address - Phone:307-797-4381
Mailing Address - Fax:
Practice Address - Street 1:1341 NW LAWNRIDGE AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1217
Practice Address - Country:US
Practice Address - Phone:307-797-4381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY22125163WR0006X, 163W00000X
OR201910321RN163WR0006X, 163W00000X
UT9170887-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163W00000XNursing Service ProvidersRegistered Nurse