Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 415 | AK |
NPI | 1083720247 |
---|---|
Provider Name | Zulene O. Simmons |
First Address | Chugiak, AK 99567-6414 |
Second Address | Chugiak, AK 99567 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |