Individual
STACY I SUMMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
4424 E FLAMINGO AVE STE 110, NAMPA, ID 83687-9291
(208) 302-3200
(208) 302-3255
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1787
ID
363A00000X
Physician Assistant
PA16583
CA
363AS0400X
Surgical Physician Assistant
PA-1787
ID
Other
Enumeration date
10/03/2005
Last updated
02/21/2024
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