Provider Demographics
NPI:1518693563
Name:PAUL, ANGELETTE SUMMERS
Entity Type:Individual
Prefix:
First Name:ANGELETTE
Middle Name:SUMMERS
Last Name:PAUL
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 1:1935 WOODVALLEY CT
Mailing Address - Street 2:
Mailing Address - City:SEMMES
Mailing Address - State:AL
Mailing Address - Zip Code:36575-7410
Mailing Address - Country:US
Mailing Address - Phone:251-510-4565
Mailing Address - Fax:
Practice Address - Street 1:7272 THEODORE DAWES RD STE B
Practice Address - Street 2:
Practice Address - City:THEODORE
Practice Address - State:AL
Practice Address - Zip Code:36582-4136
Practice Address - Country:US
Practice Address - Phone:251-607-6653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-30
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-090614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily