Healthcare Provider Details

I. General information

NPI: 1740066273
Provider Name (Legal Business Name): GRACE MAE SIMMONS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 SWAN ST
BATAVIA NY
14020-3292
US

IV. Provider business mailing address

1473 EXCHANGE ST
ALDEN NY
14004-1318
US

V. Phone/Fax

Practice location:
  • Phone: 585-250-4567
  • Fax:
Mailing address:
  • Phone: 716-462-0718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF352695
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: