Provider Demographics
NPI:1912266123
Name:SIMKOWITZ-ROGERS, ANNABRYN (LAC)
Entity Type:Individual
Prefix:
First Name:ANNABRYN
Middle Name:
Last Name:SIMKOWITZ-ROGERS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 S RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8523
Mailing Address - Country:US
Mailing Address - Phone:406-728-1600
Mailing Address - Fax:
Practice Address - Street 1:3031 S RUSSELL ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8523
Practice Address - Country:US
Practice Address - Phone:406-728-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15736171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist