Provider Demographics
NPI:1104062082
Name:SIMMONDS NELSON, MICHELLE ALYSON (PHD, RN, MS, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ALYSON
Last Name:SIMMONDS NELSON
Suffix:
Gender:F
Credentials:PHD, RN, MS, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256C MASON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3408
Mailing Address - Country:US
Mailing Address - Phone:718-226-6231
Mailing Address - Fax:718-226-6164
Practice Address - Street 1:256C MASON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3408
Practice Address - Country:US
Practice Address - Phone:718-226-6231
Practice Address - Fax:718-226-6164
Is Sole Proprietor?:No
Enumeration Date:2008-12-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333283363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily