Healthcare Provider Details

I. General information

NPI: 1528722519
Provider Name (Legal Business Name): MRS. LAURA ALICIA SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS LAURA ALICIA TEJEDA

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 SUMMERFIELD PL SW
ALBUQUERQUE NM
87121-8356
US

IV. Provider business mailing address

1408 SUMMERFIELD PL SW
ALBUQUERQUE NM
87121-8356
US

V. Phone/Fax

Practice location:
  • Phone: 505-570-1033
  • Fax:
Mailing address:
  • Phone: 505-570-1033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number71200
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number71200
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: