Provider Demographics
NPI:1912239054
Name:BURGESS, SUMMER M (LPN)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:M
Last Name:BURGESS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:M
Other - Last Name:ATKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42 HICKORY STREET
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701
Mailing Address - Country:US
Mailing Address - Phone:740-818-3264
Mailing Address - Fax:740-589-5510
Practice Address - Street 1:13115 CARR RD
Practice Address - Street 2:
Practice Address - City:NELSONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45764-9550
Practice Address - Country:US
Practice Address - Phone:740-818-3955
Practice Address - Fax:740-589-5510
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-112231 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse