Healthcare Provider Details

I. General information

NPI: 1669723094
Provider Name (Legal Business Name): ADELINE A SIMMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 HAMPTON POINT DR # A
SILVER SPRING MD
20904
US

IV. Provider business mailing address

3303 HAMPTON POINT DR APT A
SILVER SPRING MD
20904-4862
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-8340
  • Fax:
Mailing address:
  • Phone: 202-832-8340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number192239
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: