Basic Information
| Provider Information | |||||||||
| NPI: | 1003822776 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUMMERFIELD | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | APRN, CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 WASHINGTON BLVD | ||||||||
| Address2: | SUITE 440 | ||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069012216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033482614 | ||||||||
| FaxNumber: | 2033258677 | ||||||||
| Practice Location | |||||||||
| Address1: | 1055 WASHINGTON BLVD | ||||||||
| Address2: | SUITE 440 | ||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069012216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033482614 | ||||||||
| FaxNumber: | 2033258677 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 06/11/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 001123 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 004213766 | 05 | CT | MEDICAID |