Provider Demographics
NPI:1023564077
Name:SIMONS, HEATHER (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:SIMONS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AUF WALGEN 20
Mailing Address - Street 2:
Mailing Address - City:ALTENKIRCHEN
Mailing Address - State:RHEINLAND-PFALZ
Mailing Address - Zip Code:66903
Mailing Address - Country:DE
Mailing Address - Phone:401515-677-9290
Mailing Address - Fax:
Practice Address - Street 1:5525 FAIRFAX DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-2453
Practice Address - Country:US
Practice Address - Phone:703-341-7204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-141214163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant