Provider Demographics
NPI:1285011122
Name:SUMMERS, RAEBETH (RN)
Entity Type:Individual
Prefix:
First Name:RAEBETH
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:TX
Mailing Address - Zip Code:76520-3934
Mailing Address - Country:US
Mailing Address - Phone:254-697-7039
Mailing Address - Fax:254-697-4809
Practice Address - Street 1:209 S HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:TX
Practice Address - Zip Code:76520-3934
Practice Address - Country:US
Practice Address - Phone:254-697-7039
Practice Address - Fax:254-697-4809
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX597119163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse