Provider Demographics
NPI:1124174156
Name:SIMMONS, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 205TH RD
Mailing Address - Street 2:
Mailing Address - City:LEONA
Mailing Address - State:KS
Mailing Address - Zip Code:66532-9538
Mailing Address - Country:US
Mailing Address - Phone:785-359-6567
Mailing Address - Fax:
Practice Address - Street 1:316 205TH RD
Practice Address - Street 2:
Practice Address - City:LEONA
Practice Address - State:KS
Practice Address - Zip Code:66532-9538
Practice Address - Country:US
Practice Address - Phone:785-359-6567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Not Answered3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant