Provider Demographics
NPI:1548553803
Name:SUMMERFIELD FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:SUMMERFIELD FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANDINE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, ANP, BC
Authorized Official - Phone:317-408-8480
Mailing Address - Street 1:11 DECLARATION DR
Mailing Address - Street 2:N
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7283
Mailing Address - Country:US
Mailing Address - Phone:317-886-7417
Mailing Address - Fax:317-886-7681
Practice Address - Street 1:11 DECLARATION DR
Practice Address - Street 2:N
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-7283
Practice Address - Country:US
Practice Address - Phone:317-886-7417
Practice Address - Fax:317-886-7671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28084354163W00000X
IN01042621A207L00000X
IN71000246A363LF0000X
IN71003812A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty