Provider Demographics
NPI:1528722519
Name:SIMMONS, LAURA ALICIA
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ALICIA
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:ALICIA
Other - Last Name:TEJEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1408 SUMMERFIELD PL SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-8356
Mailing Address - Country:US
Mailing Address - Phone:505-570-1033
Mailing Address - Fax:
Practice Address - Street 1:1408 SUMMERFIELD PL SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-8356
Practice Address - Country:US
Practice Address - Phone:505-570-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM71200163WS0200X
TX71200163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WS0200XNursing Service ProvidersRegistered NurseSchool