Provider Demographics
NPI:1255507828
Name:SUMMERS, GEORGIA A (NP)
Entity Type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:A
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-0260
Mailing Address - Country:US
Mailing Address - Phone:906-485-2143
Mailing Address - Fax:906-486-6898
Practice Address - Street 1:425 CORNING ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-9306
Practice Address - Country:US
Practice Address - Phone:906-249-1996
Practice Address - Fax:906-486-6898
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704119201363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner