Provider Demographics
NPI:1477921989
Name:SIMMONS, LEA
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:
Other - Last Name:BURROWS-BRIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1575 RAMBLEWOOD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6384
Mailing Address - Country:US
Mailing Address - Phone:517-827-1800
Mailing Address - Fax:517-827-1805
Practice Address - Street 1:1575 RAMBLEWOOD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6384
Practice Address - Country:US
Practice Address - Phone:517-827-1800
Practice Address - Fax:517-827-1805
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007477363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI7206055Medicare PIN