Healthcare Provider Details

I. General information

NPI: 1508528514
Provider Name (Legal Business Name): ANNETTE MARIE SIMMONS PMHNP-BC, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNETTE MARIE KOWALCZYK DNP, APRN, FNP-BC

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 S RIVER RD
DES PLAINES IL
60018-1759
US

IV. Provider business mailing address

1407 S RIVER RD
DES PLAINES IL
60018-1759
US

V. Phone/Fax

Practice location:
  • Phone: 224-285-6783
  • Fax: 312-872-7935
Mailing address:
  • Phone: 224-285-6783
  • Fax: 312-872-7935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.023927
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.023927
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: