Provider Demographics
NPI:1275501124
Name:SUMERFELT, ANDREA KRISTINE (AT,C)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:KRISTINE
Last Name:SUMERFELT
Suffix:
Gender:F
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-1378
Mailing Address - Country:US
Mailing Address - Phone:815-622-4181
Mailing Address - Fax:815-622-4157
Practice Address - Street 1:1608 4TH AVE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-1378
Practice Address - Country:US
Practice Address - Phone:815-622-4181
Practice Address - Fax:815-622-4157
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist