MEDICARE: MRS. WYLENE B SIMMONS-ELLINGTON LICENSED MIDWIFE

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	175M00000X	Lay Midwife	MW122	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y4971	OTHER	FL	BLUE CROSS BLUE SHEILD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639358716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WYLENE B SIMMONS-ELLINGTON LICENSED MIDWIFE

Provider Business Mailing Address
First Line	:	2331 N STATE ROAD 7 STE 124
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-3771
Country	:	US
Telephone Number	:	954-484-7698
Fax Number	:

Provider Business Practice Location Address
First Line	:	2331 N STATE ROAD 7 STE 124
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-3771
Country	:	US
Telephone Number	:	954-484-7698
Fax Number	:

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

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	10/25/2007

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Directions to “ MRS. WYLENE B SIMMONS-ELLINGTON LICENSED MIDWIFE” Practice Location

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