MEDICARE: DAMIAYA SIMMONS

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1376999425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMIAYA SIMMONS

Provider Business Mailing Address
First Line	:	1129 S GRAND AVE
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48910-1613
Country	:	US
Telephone Number	:	517-614-1412
Fax Number	:

Provider Business Practice Location Address
First Line	:	1129 S GRAND AVE
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48910-1613
Country	:	US
Telephone Number	:	517-614-1412
Fax Number	:

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

Provider Enumeration Date	:	05/09/2016
Last Update Date	:	05/09/2016

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Directions to “ DAMIAYA SIMMONS ” Practice Location

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