Provider Demographics
NPI:1972221570
Name:SIMMONS, DANA
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:SIMMONS COAXUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:221 SAINT JAMES AVE STE 13A
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-3270
Mailing Address - Country:US
Mailing Address - Phone:843-793-2588
Mailing Address - Fax:
Practice Address - Street 1:221 SAINT JAMES AVE STE 13A
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3270
Practice Address - Country:US
Practice Address - Phone:843-793-2588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC105234376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherVETERAN