Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 012035 | ME |
NPI | 1003902271 |
---|---|
Provider Name | Ann P Simmons |
First Address | Calais, ME 04619-1305 |
Second Address | Calais, ME 04619-1305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C66189 | (02) |