Provider Demographics
NPI:1710386321
Name:SIMMONS, SARAH LEA (LM CPM)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LEA
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LM CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:WA
Mailing Address - Zip Code:98862-0324
Mailing Address - Country:US
Mailing Address - Phone:253-318-9484
Mailing Address - Fax:509-651-4121
Practice Address - Street 1:214 N GLOVER STREET
Practice Address - Street 2:
Practice Address - City:TWISP
Practice Address - State:WA
Practice Address - Zip Code:98856
Practice Address - Country:US
Practice Address - Phone:253-318-9484
Practice Address - Fax:509-651-4121
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60437002176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife