Healthcare Provider Details

I. General information

NPI: 1568679181
Provider Name (Legal Business Name): JANET LYNN SIMMONS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 N BERGIN LN
BLOOMFIELD NM
87413-6729
US

IV. Provider business mailing address

5416 VILLA VIEW DR
FARMINGTON NM
87402-8269
US

V. Phone/Fax

Practice location:
  • Phone: 505-632-4356
  • Fax: 505-634-3872
Mailing address:
  • Phone: 505-632-4356
  • Fax: 505-634-3872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR30172
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: