Provider Demographics
NPI:1306459797
Name:JEFFREY, SUMMER DAWN
Entity type:Individual
Prefix:MS
First Name:SUMMER
Middle Name:DAWN
Last Name:JEFFREY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SUMMER
Other - Middle Name:DAWN
Other - Last Name:RUF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 COOPER POINT RD SW STE 100
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1172
Mailing Address - Country:US
Mailing Address - Phone:360-596-4800
Mailing Address - Fax:877-521-3654
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-774-3102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61238845363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program