Provider Demographics
NPI:1730468950
Name:SIMMONS, BRYNN LOUISE
Entity Type:Individual
Prefix:
First Name:BRYNN
Middle Name:LOUISE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRYNN
Other - Middle Name:LOUISE
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPA-C
Mailing Address - Street 1:PO BOX 171
Mailing Address - Street 2:
Mailing Address - City:COLLINS CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14035-0171
Mailing Address - Country:US
Mailing Address - Phone:716-532-5609
Mailing Address - Fax:
Practice Address - Street 1:43 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-6115
Practice Address - Country:US
Practice Address - Phone:716-690-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014909363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant