Provider Demographics
NPI:1841018116
Name:SUMMERS, MICHELE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
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 1:1341 8TH AVE N APT 14
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-3441
Mailing Address - Country:US
Mailing Address - Phone:701-404-5942
Mailing Address - Fax:
Practice Address - Street 1:1341 8TH AVE N APT 14
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-3441
Practice Address - Country:US
Practice Address - Phone:701-404-5942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility