Provider Demographics
NPI:1962677351
Name:SUMNER, JASON ROBERT (RN)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ROBERT
Last Name:SUMNER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 KENSINGTON AVE
Mailing Address - Street 2:APT. 2
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-3351
Mailing Address - Country:US
Mailing Address - Phone:804-690-5209
Mailing Address - Fax:
Practice Address - Street 1:2704 KENSINGTON AVE
Practice Address - Street 2:APT. 2
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-3351
Practice Address - Country:US
Practice Address - Phone:804-690-5209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001212010163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse