| NPI | 1255643417 |
|---|---|
| Former Name | STACY LYNN SUMMERS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3038-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.003773) |
| Enumeration Date | 2010-07-05 |
| Last Update Date | 2024-03-12 |