Provider Demographics
NPI:1427076900
Name:SUMMERS, SANDRA M (PNP)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:M
Last Name:SUMMERS
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Gender:F
Credentials:PNP
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Mailing Address - Street 1:1 CHILDRENS PL
Mailing Address - Street 2:MSC 8515-87-1200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-747-6173
Mailing Address - Fax:314-454-2412
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV PED GASTRO, HEPATOLOGY & NUTRITION
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6173
Practice Address - Fax:844-231-8912
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-11-15
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Provider Licenses
StateLicense IDTaxonomies
MO072444363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428891220Medicaid
ILENROLLEDMedicaid