Provider Demographics
NPI:1902561533
Name:POLSELLI, SUMMER CAITLYN
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:CAITLYN
Last Name:POLSELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 W WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-4574
Mailing Address - Country:US
Mailing Address - Phone:702-971-0164
Mailing Address - Fax:
Practice Address - Street 1:3001 W WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-4574
Practice Address - Country:US
Practice Address - Phone:702-971-0164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date: