Basic Information
Provider Information
NPI: 1184244980
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MEADOWS
FirstName: SUMMER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 601 AVERY ST STE 501
Address2:  
City: PARKERSBURG
State: WV
PostalCode: 261015192
CountryCode: US
TelephoneNumber: 3045888683
FaxNumber: 3044223924
Practice Location
Address1: 800 GARFIELD AVE
Address2:  
City: PARKERSBURG
State: WV
PostalCode: 261015376
CountryCode: US
TelephoneNumber: 3044223904
FaxNumber: 3044223924
Other Information
ProviderEnumerationDate: 04/21/2020
LastUpdateDate: 04/20/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/20/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X85990WVY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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