Provider Demographics
NPI:1639413735
Name:LOFTON - DERRICK, SUMMER DAWN (CRNA)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:DAWN
Last Name:LOFTON - DERRICK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:DAWN
Other - Last Name:LOFTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:87 OLD BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5345
Mailing Address - Country:US
Mailing Address - Phone:972-998-5402
Mailing Address - Fax:
Practice Address - Street 1:87 OLD BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801
Practice Address - Country:US
Practice Address - Phone:972-998-5402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY92518367500000X
NY563877163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered