| Doctor Name: | LANISSA RAE SUMMEROUR |
| NPI Number: | 1841571957 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-BC |
| License Number: | RN130632 |
| Business Practice Address: | 761 N Cherokee Rd Social Circle, GA - 300254019 |
| Business Phone Number: | 7704644434 |
| Business Fax Number: | |
| Mailing Address: | 3850 Mount Carmel Church Rd, MONROE |
| State: | GA |
| Postal Code: | 306555343 |
| Phone Number: | 7066213103 |
| Fax Number: | |
| NPI Enumeration Date: | 09/01/2011 |
| NPI Last Update Date: | 09/01/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN130632 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |