Provider Demographics
NPI:1639839475
Name:SIMMONS, EMILY (MS, RD, CD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 W MILL RD
Mailing Address - Street 2:UNIT 224
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2225 W MILL RD
Practice Address - Street 2:UNIT 224
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209
Practice Address - Country:US
Practice Address - Phone:920-471-2736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered