Provider Demographics
NPI:1174716484
Name:WILLIAMS-SIMMONS, CAMILLE A (NP)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:A
Last Name:WILLIAMS-SIMMONS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 W 142ND ST
Mailing Address - Street 2:
Mailing Address - City:DIXMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60426-1173
Mailing Address - Country:US
Mailing Address - Phone:708-489-5488
Mailing Address - Fax:
Practice Address - Street 1:110 E SCHILLER ST
Practice Address - Street 2:SUITE 319
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2858
Practice Address - Country:US
Practice Address - Phone:630-832-1775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.006484 041.26975363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner