MEDICARE: BRIDGETT SIMMONS APN

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	363LF0000X	Family Nurse Practitioner	209012911	IL
2	363LX0106X	Occupational Health Nurse Practitioner	209012911	IL

General Provider Information

NPI Number	:	1902289879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGETT SIMMONS APN

Provider Business Mailing Address
First Line	:	10150 E NORTH LAKE DR
Second Line	:
City	:	NEWTON
State	:	IL
Zip	:	62448-3461
Country	:	US
Telephone Number	:	217-343-0948
Fax Number	:

Provider Business Practice Location Address
First Line	:	10150 E NORTH LAKE DR
Second Line	:
City	:	NEWTON
State	:	IL
Zip	:	62448-3461
Country	:	US
Telephone Number	:	217-343-0948
Fax Number	:

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

Provider Enumeration Date	:	07/09/2015
Last Update Date	:	01/14/2016

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