MEDICARE: EMILY SIMMONS MS, RD, CD

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1639839475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY SIMMONS MS, RD, CD

Provider Business Mailing Address
First Line	:	W274N1144 ROLLING RIDGE DR
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53188-1239
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	W274N1144 ROLLING RIDGE DR
Second Line	:
City	:	WAUKESHA
State	:	WI
Zip	:	53188-1239
Country	:	US
Telephone Number	:	920-471-2736
Fax Number	:

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

Provider Enumeration Date	:	12/21/2021
Last Update Date	:	06/18/2026

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