Healthcare Provider Details

I. General information

NPI: 1174716484
Provider Name (Legal Business Name): CAMILLE A WILLIAMS-SIMMONS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 09/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E SCHILLER ST SUITE 319
ELMHURST IL
60126-2858
US

IV. Provider business mailing address

2025 W 142ND ST
DIXMOOR IL
60426-1173
US

V. Phone/Fax

Practice location:
  • Phone: 630-832-1775
  • Fax:
Mailing address:
  • Phone: 708-489-5488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.006484 041.26975
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: