Provider Demographics
NPI:1710749130
Name:SUMLIN, IOLA
Entity Type:Individual
Prefix:
First Name:IOLA
Middle Name:
Last Name:SUMLIN
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 1:662 STAGS LEAP CT
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8729
Mailing Address - Country:US
Mailing Address - Phone:336-456-6263
Mailing Address - Fax:
Practice Address - Street 1:7 DUNDAS CIR STE G
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1645
Practice Address - Country:US
Practice Address - Phone:336-456-6362
Practice Address - Fax:336-617-0007
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01DPTB4146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant