Provider Demographics
NPI:1740066273
Name:SIMMONS, GRACE MAE (FNP-C)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:MAE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1473 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-1318
Mailing Address - Country:US
Mailing Address - Phone:716-462-0718
Mailing Address - Fax:
Practice Address - Street 1:34 SWAN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3292
Practice Address - Country:US
Practice Address - Phone:585-250-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF352695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine