Basic Information
| Provider Information | |||||||||
| NPI: | 1225363922 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMMONS | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | C.R.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9956 N MAIN ST | ||||||||
| Address2: | UNIT 2 | ||||||||
| City: | BERLIN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218111077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106419568 | ||||||||
| FaxNumber: | 4106411006 | ||||||||
| Practice Location | |||||||||
| Address1: | 9956 NORTH MAIN STREET | ||||||||
| Address2: | UNIT 2 | ||||||||
| City: | BERLIN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218111060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106419568 | ||||||||
| FaxNumber: | 4106411006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2009 | ||||||||
| LastUpdateDate: | 02/13/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R160125 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.