Provider Demographics
NPI:1275859282
Name:SUMMEROW, VALARIE CRISP (MSN, ANPBC)
Entity Type:Individual
Prefix:
First Name:VALARIE
Middle Name:CRISP
Last Name:SUMMEROW
Suffix:
Gender:F
Credentials:MSN, ANPBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4358
Mailing Address - Country:US
Mailing Address - Phone:704-874-1904
Mailing Address - Fax:704-867-2134
Practice Address - Street 1:133 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-3005
Practice Address - Country:US
Practice Address - Phone:828-994-4544
Practice Address - Fax:828-624-0546
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004622363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner