Provider Demographics
NPI:1306453535
Name:SUMMERS, MARY
Entity type:Individual
Prefix:
First Name:MARY
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:PO BOX 632
Mailing Address - Street 2:
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836-0632
Mailing Address - Country:US
Mailing Address - Phone:304-530-2256
Mailing Address - Fax:304-530-6989
Practice Address - Street 1:409 SPRING AVE
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-1036
Practice Address - Country:US
Practice Address - Phone:304-530-2256
Practice Address - Fax:304-530-6989
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker