Provider Demographics
NPI:1326564733
Name:SUMMERS, MONIQUE LAVAE (RN)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:LAVAE
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 1:7301 E MAIN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-5134
Mailing Address - Country:US
Mailing Address - Phone:505-436-6023
Mailing Address - Fax:
Practice Address - Street 1:7301 E MAIN ST APT 1
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-5134
Practice Address - Country:US
Practice Address - Phone:505-436-6023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-87269163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool