Healthcare Provider Details

I. General information

NPI: 1720539018
Provider Name (Legal Business Name): WANDA SIMMONS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 AMBERWOOD PKWY # 0
ASHLAND OH
44805-9765
US

IV. Provider business mailing address

1025 BRUSHMORE AVE NW
NORTH CANTON OH
44720-6120
US

V. Phone/Fax

Practice location:
  • Phone: 419-896-4282
  • Fax:
Mailing address:
  • Phone: 313-617-8063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP019767
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP019767
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: