Provider Demographics
NPI:1114923018
Name:SIMMONS, JANICE D (ARNP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:D
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 W CENTRAL PARK AVE
Mailing Address - Street 2:STE 420
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-1853
Mailing Address - Country:US
Mailing Address - Phone:563-421-1422
Mailing Address - Fax:563-421-1430
Practice Address - Street 1:1351 W CENTRAL PARK AVE
Practice Address - Street 2:STE 420
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-1853
Practice Address - Country:US
Practice Address - Phone:563-421-1422
Practice Address - Fax:563-421-1430
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAL101908363LA2100X
IL363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA09751OtherWELLMARK OF IA
IAIA0182OtherJOHN DEERE
IA1462978Medicaid
IAI17444Medicare PIN
IA09751OtherWELLMARK OF IA