Healthcare Provider Details

I. General information

NPI: 1982711685
Provider Name (Legal Business Name): HOLLY SIMMONS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ALUMNI DR
EXETER NH
03833-2160
US

IV. Provider business mailing address

300 MAIN ST
LEWISTON ME
04240-7027
US

V. Phone/Fax

Practice location:
  • Phone: 603-778-7311
  • Fax:
Mailing address:
  • Phone: 207-795-5775
  • Fax: 207-795-5653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR037707
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: