Provider Demographics
NPI:1386825552
Name:SUMNER, LAURA (APRN,BC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:SUMNER
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HAWTHORNE PL
Mailing Address - Street 2:SUITE, 105
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2333
Mailing Address - Country:US
Mailing Address - Phone:617-726-8441
Mailing Address - Fax:617-248-9665
Practice Address - Street 1:1 HAWTHORNE PL
Practice Address - Street 2:SUITE, 105
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2333
Practice Address - Country:US
Practice Address - Phone:617-726-8441
Practice Address - Fax:617-248-9665
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157399363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health