Provider Demographics
NPI:1699897165
Name:ROSS, SUMMER LYNN (PA)
Entity type:Individual
Prefix:MRS
First Name:SUMMER
Middle Name:LYNN
Last Name:ROSS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3184 CHURN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2122
Mailing Address - Country:US
Mailing Address - Phone:530-768-2436
Mailing Address - Fax:530-768-2450
Practice Address - Street 1:3184 CHURN CREEK RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2122
Practice Address - Country:US
Practice Address - Phone:530-768-2436
Practice Address - Fax:530-768-2450
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17629363A00000X
CAPA17629363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q40982Medicare UPIN