Provider Demographics
NPI:1326689894
Name:ACKLEY, SUMER LEA (FNP)
Entity Type:Individual
Prefix:MS
First Name:SUMER
Middle Name:LEA
Last Name:ACKLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 W LINDNER AVE UNIT 115
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6531
Mailing Address - Country:US
Mailing Address - Phone:480-274-7048
Mailing Address - Fax:
Practice Address - Street 1:1920 W LINDNER AVE UNIT 115
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6531
Practice Address - Country:US
Practice Address - Phone:480-274-7048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRNP233158363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily