Healthcare Provider Details

I. General information

NPI: 1538258520
Provider Name (Legal Business Name): THERESA L. SIMMONS C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 POLE CREEK XING
SIDNEY NE
69162-2901
US

IV. Provider business mailing address

1000 POLE CREEK CROSSING
SIDNEY NE
69162-2900
US

V. Phone/Fax

Practice location:
  • Phone: 308-254-5825
  • Fax: 308-254-0396
Mailing address:
  • Phone: 308-254-5825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101379
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: