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Dyan J Summers

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

9900 Bren Road East, Mail Route Mn 008-B213, Minnentonka, MN 55343

PECOS Enrollment

This provider is enrolled in PECOS as DYAN SUMMERS.

Based on the most recent information from CMS, provider Dyan J Summers is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1144406968
Provider Type
Individual
Full Name
Summers, Dyan J
Credential
DNP, MPH

Gender
Female
Sole Proprietor
Yes
Enumeration Date
1/10/2008
Last Updated
4/15/2021

Contact Information

Practice Location

9900 Bren Road East, Mail Route Mn 008-B213, Minnentonka, MN 55343

(646) 319-3707

Unlisted Fax

Mailing Location

749 Linden Pl, Idaho Falls, ID 83401-4966

(646) 319-3707

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363L00000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 125717 Montana
Code 163WH0200X	Description Registered Nurse Nursing Service Providers	License 441410-1 New York
Code 163WH0200X	Description Registered Nurse Nursing Service Providers	License 53753 Idaho
Code 363LA2200X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 303234 New York
Code 363LA2200X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 53753 Idaho
Code 363LA2200X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 125717 Montana
Code 363LA2200X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 14903 California

Dyan J Summers

PECOS Enrollment

Profile Details

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