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NPI Code Detail

MEDICARE: MICHAEL ANTHONY SIMMONS RN

MEDICARE:   MICHAEL ANTHONY SIMMONS  RN
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
1163W00000XRegistered Nurse041387765IL
2164W00000XLicensed Practical NurseLPN078306GA
3164W00000XLicensed Practical Nurse043100800IL

General Provider Information

NPI Number : 1760784219
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL ANTHONY SIMMONS RN
Provider Business Mailing Address
First Line : 1414 N AUSTIN BLVD
Second Line : 3W
City : OAK PARK
State : IL
Zip : 60302-1174
Country : US
Telephone Number : 773-991-0960
Fax Number :
Provider Business Practice Location Address
First Line : 1414 N AUSTIN BLVD
Second Line : 3W
City : OAK PARK
State : IL
Zip : 60302-1174
Country : US
Telephone Number : 773-991-0960
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2010
Last Update Date : 12/02/2010

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Directions to “ MICHAEL ANTHONY SIMMONS RN” Practice Location

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