Provider Demographics
NPI:1235462011
Name:SUMMERS, STACY (CSA)
Entity Type:Individual
Prefix:PROF
First Name:STACY
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 SAINT MARYS DR STE 201E
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0518
Mailing Address - Country:US
Mailing Address - Phone:812-575-9343
Mailing Address - Fax:812-471-8322
Practice Address - Street 1:801 SAINT MARYS DR STE 201E
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0518
Practice Address - Country:US
Practice Address - Phone:812-575-9343
Practice Address - Fax:812-471-8322
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant