Provider Demographics
NPI:1689116634
Name:SUMSION, JAN
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:SUMSION
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 1:3298 N COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4498
Mailing Address - Country:US
Mailing Address - Phone:801-380-5571
Mailing Address - Fax:
Practice Address - Street 1:3298 N COTTONWOOD LN
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4498
Practice Address - Country:US
Practice Address - Phone:801-380-5571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT187052-3102163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant