MEDICARE: HOLLY D SIMMS CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	071407	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063611432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY D SIMMS CRNA

Provider Business Mailing Address
First Line	:	2 TRAP FALLS ROAD
Second Line	:	SUITE 414
City	:	SHELTON
State	:	CT
Zip	:	06484
Country	:	US
Telephone Number	:	203-929-7353
Fax Number	:	203-929-0756

Provider Business Practice Location Address
First Line	:	99 EAST RIVER DRIVE
Second Line	:	5TH FLOOR
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-7301
Country	:	US
Telephone Number	:	860-282-0833
Fax Number	:	860-282-0170

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	10/10/2016

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