Provider Demographics
NPI:1881441905
Name:SIMMONS, CHANIECE RACHAUN (WHNP-BC)
Entity type:Individual
Prefix:MS
First Name:CHANIECE
Middle Name:RACHAUN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E CHARLES ST STE 104
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-4901
Mailing Address - Country:US
Mailing Address - Phone:301-609-4800
Mailing Address - Fax:240-901-2958
Practice Address - Street 1:101 E CHARLES ST STE 104
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-4901
Practice Address - Country:US
Practice Address - Phone:301-609-4800
Practice Address - Fax:240-901-2958
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR225247363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology