Provider Demographics
NPI:1518483254
Name:SIMMONS, WHISPER JEAN
Entity Type:Individual
Prefix:MS
First Name:WHISPER
Middle Name:JEAN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 MYRTLE ST NW APT 1
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-3057
Mailing Address - Country:US
Mailing Address - Phone:317-413-1862
Mailing Address - Fax:
Practice Address - Street 1:838 MYRTLE ST NW APT 1
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-3057
Practice Address - Country:US
Practice Address - Phone:317-413-1862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide