Healthcare Provider Details

I. General information

NPI: 1164875118
Provider Name (Legal Business Name): DAWN SIMMS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SILVER CROSS BLVD
NEW LENOX IL
60451-9509
US

IV. Provider business mailing address

12525 RAIL LN
PALOS PARK IL
60464-1543
US

V. Phone/Fax

Practice location:
  • Phone: 815-300-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041341554
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: