Provider Demographics
NPI:1760970768
Name:SUMMEY, ANDRA R
Entity Type:Individual
Prefix:
First Name:ANDRA
Middle Name:R
Last Name:SUMMEY
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 1:8210 DEODORA CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-7140
Mailing Address - Country:US
Mailing Address - Phone:980-216-6586
Mailing Address - Fax:
Practice Address - Street 1:8210 DEODORA CEDAR LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-7140
Practice Address - Country:US
Practice Address - Phone:980-216-6586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator