Provider Demographics
NPI:1851144315
Name:SIMMONS, CHRISTIAN DEAN
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:DEAN
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2052 E GRAYSTONE CT
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9120
Mailing Address - Country:US
Mailing Address - Phone:801-889-7136
Mailing Address - Fax:
Practice Address - Street 1:2052 E GRAYSTONE CT
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9120
Practice Address - Country:US
Practice Address - Phone:801-889-7136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program