Healthcare Provider Details

I. General information

NPI: 1275077372
Provider Name (Legal Business Name): VONTRESE L SIMPSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VONTRESE L WARREN APRN

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10440 LITTLE PATUXENT PKWY STE 300
COLUMBIA MD
21044-3648
US

IV. Provider business mailing address

300 REXBURG AVE
FORT WASHINGTON MD
20744-6103
US

V. Phone/Fax

Practice location:
  • Phone: 502-553-9710
  • Fax:
Mailing address:
  • Phone: 502-553-9710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number3009157
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024177446
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP130816
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR246642
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP1054476
License Number StateDC
# 6
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberTPAN2367
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: