Provider Demographics
NPI:1962627661
Name:SUMMERS, LISA ANNETTE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNETTE
Last Name:SUMMERS
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 1:502 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-6120
Mailing Address - Country:US
Mailing Address - Phone:704-873-4844
Mailing Address - Fax:
Practice Address - Street 1:502 S CENTER ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-6120
Practice Address - Country:US
Practice Address - Phone:704-873-4844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator