Provider Demographics
NPI:1184934978
Name:SUMMERS, COLLEEN (APN-BC)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MALL RD
Mailing Address - Street 2:LAHEY CLINIC
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8400
Mailing Address - Fax:781-744-5245
Practice Address - Street 1:6 TSIENNTO ROAD
Practice Address - Street 2:SUITE 101LL
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038
Practice Address - Country:US
Practice Address - Phone:781-744-8400
Practice Address - Fax:781-744-5245
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN/NP2259447363L00000X
NH067080-21363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110095056AMedicaid
NH3087936Medicaid
NH003113503Medicare PIN
NH3087936Medicaid