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General NPI Number Information
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NPI Number | 1790942183
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Entity Type | Individual
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Provider Name | SHELLEY A SIMMERING CPED
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Gender | Female
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 303 N 2ND ST SUITE 10
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City | ST CHARLES
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State | IL
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Zip | 60174-1804
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Country | US
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Telephone | 630-740-6331
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Fax | 630-587-5537
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Provider Business Mailing Address
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Address Line | 303 N 2ND ST SUITE 10
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City | ST CHARLES
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State | IL
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Zip | 60174-1804
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Country | US
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Telephone | 630-740-6331
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Fax | 630-587-5537
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 212-000134
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License Number State | IL
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