Provider Demographics
NPI:1295591923
Name:SIMMONS, DONNA JEAN (NBC-HWC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4123 CORNWALL ST
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1660
Mailing Address - Country:US
Mailing Address - Phone:124-876-3203
Mailing Address - Fax:
Practice Address - Street 1:4123 CORNWALL ST
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1660
Practice Address - Country:US
Practice Address - Phone:124-876-3203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIA-3255023171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach