Healthcare Provider Details

I. General information

NPI: 1083720247
Provider Name (Legal Business Name): ZULENE O. SIMMONS ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20905 EASTSIDE DRIVE #1
CHUGIAK AK
99567
US

IV. Provider business mailing address

19722 LACE RD
CHUGIAK AK
99567-6414
US

V. Phone/Fax

Practice location:
  • Phone: 907-688-0901
  • Fax: 907-688-0830
Mailing address:
  • Phone: 907-688-2559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number415
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: