Provider Demographics
NPI:1043320880
Name:SIMMONS, CAROL JEAN (FNP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:JEAN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:JEAN
Other - Last Name:REMPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10801 SE MILL CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-3219
Mailing Address - Country:US
Mailing Address - Phone:503-257-9835
Mailing Address - Fax:
Practice Address - Street 1:5941 N CENTRAL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203
Practice Address - Country:US
Practice Address - Phone:503-988-3909
Practice Address - Fax:503-988-5907
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000033517N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORS95497Medicare UPIN