Provider Demographics
NPI:1588448310
Name:SUMRALL, EMILY (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:SUMRALL
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1548 VOLPONI DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-2785
Mailing Address - Country:US
Mailing Address - Phone:940-206-2649
Mailing Address - Fax:
Practice Address - Street 1:622 W MAPLE ST STE B
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6589
Practice Address - Country:US
Practice Address - Phone:505-327-4867
Practice Address - Fax:505-327-5355
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM57288163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse