Provider Demographics
NPI:1275077372
Name:SIMPSON, VONTRESE L (APRN)
Entity Type:Individual
Prefix:MRS
First Name:VONTRESE
Middle Name:L
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 REXBURG AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-6103
Mailing Address - Country:US
Mailing Address - Phone:502-553-9710
Mailing Address - Fax:
Practice Address - Street 1:605 CHARLES ST
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5973
Practice Address - Country:US
Practice Address - Phone:301-609-5006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009157363LW0102X
DCNP1054476363LW0102X
MDR246642363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health