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General NPI Number Information
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NPI Number | 1235774787
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Entity Type | Individual
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Provider Name | VELISA SIMMONS
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Gender | Female
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Dates
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Enumeration Date | 11/07/2019
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Last Update Date | 11/07/2019
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Provider Practice Location Address
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Address Line | 140 T ST NE
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City | WASHINGTON
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State | DC
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Zip | 20002-1579
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Country | US
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Telephone | 240-353-7469
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Fax |
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Provider Business Mailing Address
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Address Line | 4408 G ST SE APT 33
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City | WASHINGTON
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State | DC
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Zip | 20019-5050
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Country | US
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Telephone | 202-758-5544
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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 | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State | DC
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