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General NPI Number Information
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NPI Number | 1720539018
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Entity Type | Individual
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Provider Name | WANDA SIMMONS CNP
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Gender | Female
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 4974 HIGBEE AVE NW STE 103
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City | CANTON
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State | OH
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Zip | 44718-2562
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Country | US
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Telephone | 330-933-4691
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Fax | 855-873-7557
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Provider Business Mailing Address
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Address Line | 1032 E BRANDON BLVD STE 4567
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City | BRANDON
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State | FL
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Zip | 33511-5509
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Country | US
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Telephone | 201-474-5844
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Fax | 807-804-1324
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP019767
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License Number State | OH
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