Provider Demographics
NPI:1831313824
Name:SIMMONS, CATHY M (RNC)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:M
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 MIDAS CT
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-6967
Mailing Address - Country:US
Mailing Address - Phone:715-459-4713
Mailing Address - Fax:
Practice Address - Street 1:1355 8TH ST S
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-5265
Practice Address - Country:US
Practice Address - Phone:715-423-9610
Practice Address - Fax:715-423-7753
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54190-030363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI54190030OtherRN LICENSE