Provider Demographics
NPI:1518452895
Name:SUMMERVILLE, NAKIAH QUIANNA
Entity Type:Individual
Prefix:
First Name:NAKIAH
Middle Name:QUIANNA
Last Name:SUMMERVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12002 YOAKUM DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-2331
Mailing Address - Country:US
Mailing Address - Phone:973-391-5029
Mailing Address - Fax:
Practice Address - Street 1:12002 YOAKUM DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-2331
Practice Address - Country:US
Practice Address - Phone:973-391-5029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX941273163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse