Healthcare Provider Details

I. General information

NPI: 1972001725
Provider Name (Legal Business Name): SUSAN SIMMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 ATLANTIC ST SW APT 203
WASHINGTON DC
20032-2353
US

IV. Provider business mailing address

40 CHESAPEAKE ST SE APT 14
WASHINGTON DC
20032-2810
US

V. Phone/Fax

Practice location:
  • Phone: 202-584-9308
  • Fax: 202-584-9308
Mailing address:
  • Phone: 202-378-6090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2247590
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: