Provider Demographics
NPI:1053679175
Name:SIMONS, ROBBYN F (LPN)
Entity Type:Individual
Prefix:
First Name:ROBBYN
Middle Name:F
Last Name:SIMONS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 PAGE GREEN RD
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-9514
Mailing Address - Country:US
Mailing Address - Phone:607-753-9326
Mailing Address - Fax:607-756-8458
Practice Address - Street 1:2806 PAGE GREEN RD
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-9514
Practice Address - Country:US
Practice Address - Phone:607-753-9326
Practice Address - Fax:607-756-8458
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308331-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY308331-1OtherNYS LPN LICENSE