Provider Demographics
NPI:1770674830
Name:SIMMONS, SUSAN G (RN, QMRP, QMHP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:G
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:RN, QMRP, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 308
Mailing Address - Street 2:
Mailing Address - City:CAVE IN ROCK
Mailing Address - State:IL
Mailing Address - Zip Code:62919-9770
Mailing Address - Country:US
Mailing Address - Phone:618-285-3361
Mailing Address - Fax:618-285-3362
Practice Address - Street 1:RR 1 BOX 99AA
Practice Address - Street 2:
Practice Address - City:GOLCONDA
Practice Address - State:IL
Practice Address - Zip Code:62938-9619
Practice Address - Country:US
Practice Address - Phone:618-285-3361
Practice Address - Fax:618-285-3362
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse