Basic Information
| Provider Information | |||||||||
| NPI: | 1124387550 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUMMERS | ||||||||
| FirstName: | KATHY | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 CATAWBA AVE | ||||||||
| Address2: | |||||||||
| City: | TURNERSVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080121646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563135121 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 US 130 N | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | CINNAMINSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568299345 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2012 | ||||||||
| LastUpdateDate: | 05/04/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 26NO08448700 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1427076553 | 05 | NJ | MEDICAID |