Provider Demographics
NPI:1083720247
Name:SIMMONS, ZULENE O (ANP)
Entity Type:Individual
Prefix:
First Name:ZULENE
Middle Name:O
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19722 LACE RD
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-6414
Mailing Address - Country:US
Mailing Address - Phone:907-688-2559
Mailing Address - Fax:
Practice Address - Street 1:20905 EASTSIDE DRIVE #1
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567
Practice Address - Country:US
Practice Address - Phone:907-688-0901
Practice Address - Fax:907-688-0830
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK415363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health