Provider Demographics
NPI:1295422111
Name:SIMMONS, IRISH ANNETTE
Entity type:Individual
Prefix:
First Name:IRISH
Middle Name:ANNETTE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 S WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:AZ
Mailing Address - Zip Code:85936-4400
Mailing Address - Country:US
Mailing Address - Phone:928-321-1965
Mailing Address - Fax:
Practice Address - Street 1:60 S WASHINGTON
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:AZ
Practice Address - Zip Code:85936-4400
Practice Address - Country:US
Practice Address - Phone:928-321-1965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9963312174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist