Healthcare Provider Details

I. General information

NPI: 1811716111
Provider Name (Legal Business Name): ERIN MICHELLE SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 STEUBENVILLE AVE
CAMBRIDGE OH
43725-2301
US

IV. Provider business mailing address

841 STEUBENVILLE AVE
CAMBRIDGE OH
43725-2301
US

V. Phone/Fax

Practice location:
  • Phone: 855-692-7247
  • Fax: 855-692-7247
Mailing address:
  • Phone: 855-692-7247
  • Fax: 855-692-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.421170
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.421170
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: