Provider Demographics
NPI:1538767918
Name:SUMMERS, MODESTA (LVN)
Entity type:Individual
Prefix:
First Name:MODESTA
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 ORMAND ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-3037
Mailing Address - Country:US
Mailing Address - Phone:830-534-6445
Mailing Address - Fax:
Practice Address - Street 1:729 ORMAND ST
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-3037
Practice Address - Country:US
Practice Address - Phone:830-534-6445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX303440164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse