Provider Demographics
NPI:1750478004
Name:SIMMS, EPHLYN U (NP)
Entity Type:Individual
Prefix:MISS
First Name:EPHLYN
Middle Name:U
Last Name:SIMMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:222 COURT ST
Mailing Address - Street 2:UNIT 226
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302
Mailing Address - Country:US
Mailing Address - Phone:508-588-2524
Mailing Address - Fax:617-282-8241
Practice Address - Street 1:90 CUSHING AVENUE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125
Practice Address - Country:US
Practice Address - Phone:617-436-8600
Practice Address - Fax:617-282-8241
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA211873363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0393380Medicaid
MA0393380Medicaid