| Doctor Name: | MRS. NICOLE RAE SUMMERS |
| NPI Number: | 1467753798 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DO |
| License Number: | 8527A |
| Business Practice Address: | 1400 Uinta Dr Green River, WY - 829355060 |
| Business Phone Number: | 3078724500 |
| Business Fax Number: | 3078724595 |
| Mailing Address: | 1400 Uinta Dr, GREEN RIVER |
| State: | WY |
| Postal Code: | 829355060 |
| Phone Number: | 3078724500 |
| Fax Number: | 3078724595 |
| NPI Enumeration Date: | 11/03/2010 |
| NPI Last Update Date: | 06/24/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 8527A |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |