MEDICARE: MRS. CATHY M SIMMONS RNC

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	363LW0102X	Women's Health Nurse Practitioner	54190-030	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	54190030	OTHER	WI	RN LICENSE

General Provider Information

NPI Number	:	1831313824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHY M SIMMONS RNC

Provider Business Mailing Address
First Line	:	3111 MIDAS CT
Second Line	:
City	:	WISCONSIN RAPIDS
State	:	WI
Zip	:	54494-6967
Country	:	US
Telephone Number	:	715-459-4713
Fax Number	:

Provider Business Practice Location Address
First Line	:	1355 8TH ST S
Second Line	:
City	:	WISCONSIN RAPIDS
State	:	WI
Zip	:	54494-5265
Country	:	US
Telephone Number	:	715-423-9610
Fax Number	:	715-423-7753

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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