Provider Demographics
NPI:1558015073
Name:WILSON, SUMMER L
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:L
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:L
Other - Last Name:HILZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1417
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-1417
Mailing Address - Country:US
Mailing Address - Phone:719-336-2600
Mailing Address - Fax:719-336-3669
Practice Address - Street 1:3501 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-4336
Practice Address - Country:US
Practice Address - Phone:719-336-3600
Practice Address - Fax:719-336-2600
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPN0041434164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse