Provider Demographics
NPI:1518381359
Name:SIMMONS, SUSAN MAURA (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MAURA
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PADDOCK WAY
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-8242
Mailing Address - Country:US
Mailing Address - Phone:781-910-6480
Mailing Address - Fax:
Practice Address - Street 1:35 PADDOCK WAY
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-8242
Practice Address - Country:US
Practice Address - Phone:781-910-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-32093163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant