Provider Demographics
NPI:1346463072
Name:SIMMONS, SARAH JANE (CNM)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:JANE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 N MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-2821
Mailing Address - Country:US
Mailing Address - Phone:773-588-6262
Mailing Address - Fax:773-588-6262
Practice Address - Street 1:4140 N MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-2821
Practice Address - Country:US
Practice Address - Phone:773-588-6262
Practice Address - Fax:773-588-6262
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2008-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041256161163W00000X
IL209002793367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364190130OtherTAX IDENTIFICATION NUMBER