MEDICARE: MR. DAVID ATO SIMMONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1477613495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID ATO SIMMONS

Provider Business Mailing Address
First Line	:	8232 EDGEWOOD AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-2524
Country	:	US
Telephone Number	:	763-300-7865
Fax Number	:	612-874-9682

Provider Business Practice Location Address
First Line	:	8232 EDGEWOOD AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-2524
Country	:	US
Telephone Number	:	763-300-7865
Fax Number	:	612-874-9682

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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