Provider Demographics
NPI:1407408537
Name:BAUMSTARK, SUMMER ELYSE (PA)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:ELYSE
Last Name:BAUMSTARK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 N 12TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2849
Mailing Address - Country:US
Mailing Address - Phone:602-839-4567
Mailing Address - Fax:602-839-2232
Practice Address - Street 1:1300 N 12TH ST STE 500
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2849
Practice Address - Country:US
Practice Address - Phone:602-839-4567
Practice Address - Fax:602-839-2232
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ7744363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical