Provider Demographics
NPI:1104691864
Name:ANTHONY, SUMMER R
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:R
Last Name:ANTHONY
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 1:233 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-8514
Mailing Address - Country:US
Mailing Address - Phone:731-661-1076
Mailing Address - Fax:
Practice Address - Street 1:131 SCARBROUGH LOOP
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343-8421
Practice Address - Country:US
Practice Address - Phone:731-661-1076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant