Provider Demographics
NPI:1477199107
Name:SUMMERVILLE, SYLVIA ANITA
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:ANITA
Last Name:SUMMERVILLE
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 1:225 S WALL ST APT 404
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-4451
Mailing Address - Country:US
Mailing Address - Phone:509-202-2801
Mailing Address - Fax:
Practice Address - Street 1:1120 W SPRAGUE AVE APT 307
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-4028
Practice Address - Country:US
Practice Address - Phone:509-202-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider