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General NPI Number Information
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NPI Number | 1174077192
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Entity Type | Individual
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Provider Name | LACONSTANCE M SIMMONS APRN PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/08/2016
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 12501 HAMILTON AVE
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City | HIGHLAND PARK
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State | MI
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Zip | 48203-3243
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Country | US
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Telephone | 313-865-1580
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Fax |
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Provider Business Mailing Address
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Address Line | 5282 BISHOP ST
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City | DETROIT
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State | MI
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Zip | 48224-2145
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Country | US
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Telephone | 313-241-2043
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704355404
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 4703116307
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License Number State | MI
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