Provider Demographics
NPI:1447730551
Name:SUMNER, LAYCEE (LPN)
Entity type:Individual
Prefix:
First Name:LAYCEE
Middle Name:
Last Name:SUMNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 ROSS CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:GA
Mailing Address - Zip Code:31092-8940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1335 N 5TH STREET EXT STE A
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3753
Practice Address - Country:US
Practice Address - Phone:229-417-9105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA096281164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse