Healthcare Provider Details

I. General information

NPI: 1932783909
Provider Name (Legal Business Name): ISABEL SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 PARKER HILL AVE
BOSTON MA
02120-3330
US

IV. Provider business mailing address

236 PARKER HILL AVE
BOSTON MA
02120-3330
US

V. Phone/Fax

Practice location:
  • Phone: 720-257-1526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN2348274
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: