Provider Demographics
NPI:1609800556
Name:SIMMONS, WENDY W (PA)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:W
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 S. 17TH ST.
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6442
Mailing Address - Country:US
Mailing Address - Phone:910-762-1182
Mailing Address - Fax:910-332-1111
Practice Address - Street 1:1710 S. 17TH ST.
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6442
Practice Address - Country:US
Practice Address - Phone:910-762-1182
Practice Address - Fax:910-332-1111
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMS0295635363A00000X
NC101041207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC101041OtherNC LICENSE
NC101041OtherNC LICENSE
NC101041OtherNC LICENSE