Provider Demographics
NPI:1275803090
Name:SUMMERS, NINA (MT)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68-090 AU ST
Mailing Address - Street 2:#512E
Mailing Address - City:WAIALUA
Mailing Address - State:HI
Mailing Address - Zip Code:96791-9451
Mailing Address - Country:US
Mailing Address - Phone:808-224-3548
Mailing Address - Fax:808-440-5617
Practice Address - Street 1:68-090 AU ST
Practice Address - Street 2:#512E
Practice Address - City:WAIALUA
Practice Address - State:HI
Practice Address - Zip Code:96791-9451
Practice Address - Country:US
Practice Address - Phone:808-224-3548
Practice Address - Fax:808-440-5617
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILMT 12326225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HILMT 12326OtherSTATE OF HI