Provider Demographics
NPI:1043028616
Name:SUMMERS, ETHAN CONNER
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:CONNER
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8044 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:OH
Mailing Address - Zip Code:45311-8947
Mailing Address - Country:US
Mailing Address - Phone:937-336-6747
Mailing Address - Fax:
Practice Address - Street 1:8044 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:OH
Practice Address - Zip Code:45311-8947
Practice Address - Country:US
Practice Address - Phone:937-336-6747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications