Provider Demographics
NPI:1952505752
Name:SUMMER, NANCY SUE (LMT)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:SUE
Last Name:SUMMER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:ESTACADA
Mailing Address - State:OR
Mailing Address - Zip Code:97023-0532
Mailing Address - Country:US
Mailing Address - Phone:503-419-8911
Mailing Address - Fax:503-668-1902
Practice Address - Street 1:17471 SHELLEY AVE
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-8084
Practice Address - Country:US
Practice Address - Phone:503-419-8911
Practice Address - Fax:503-668-1902
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6736174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist