Provider Demographics
NPI:1437456563
Name:WAUGH, SUMMER DAWN (CNP)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:DAWN
Last Name:WAUGH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16605 SOUTHWEST FREEWAY
Mailing Address - Street 2:MOB 3, SUITE 420
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479
Mailing Address - Country:US
Mailing Address - Phone:346-901-2070
Mailing Address - Fax:
Practice Address - Street 1:16605 SOUTHWEST FREEWAY
Practice Address - Street 2:MOB 3, SUITE 420
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:346-901-2070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131145363LA2100X
OHCOA.12220-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3130810Medicaid
OHH009660Medicare PIN