Provider Demographics
NPI:1720186877
Name:SIMONTON, LUCY ELLEN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:LUCY
Middle Name:ELLEN
Last Name:SIMONTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:42 WICK WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-8214
Mailing Address - Country:US
Mailing Address - Phone:936-449-5959
Mailing Address - Fax:936-597-7392
Practice Address - Street 1:1501 RIVER POINTE DR
Practice Address - Street 2:SUITE 260
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2656
Practice Address - Country:US
Practice Address - Phone:936-494-3636
Practice Address - Fax:936-494-3635
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4-20418367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered