Provider Demographics
NPI:1619633922
Name:SIMMONS, AMBER CHRISTINE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:CHRISTINE
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 1:3801 VISTA POINT WAY
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-5270
Mailing Address - Country:US
Mailing Address - Phone:323-500-3361
Mailing Address - Fax:
Practice Address - Street 1:3801 VISTA POINT WAY
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-5270
Practice Address - Country:US
Practice Address - Phone:323-500-3361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN695030164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse