Provider Demographics
NPI:1134351497
Name:SONE, SUMMELONG STANLEY (RN)
Entity type:Individual
Prefix:
First Name:SUMMELONG
Middle Name:STANLEY
Last Name:SONE
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 1:6267 VINCENT GEORGE DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8258
Mailing Address - Country:US
Mailing Address - Phone:740-591-7183
Mailing Address - Fax:
Practice Address - Street 1:6267 VINCENT GEORGE DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8258
Practice Address - Country:US
Practice Address - Phone:740-591-7183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-19
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350126163W00000X
OH0032581363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse