Provider Demographics
NPI:1093913964
Name:SIMONIS, LINDA SUSANNA (LINDA SIMONIS)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:SUSANNA
Last Name:SIMONIS
Suffix:
Gender:F
Credentials:LINDA SIMONIS
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:SUSANNA
Other - Last Name:SIMONIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LINDA SIMONIS RN,
Mailing Address - Street 1:2032 ALTA AVE
Mailing Address - Street 2:#1
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1102
Mailing Address - Country:US
Mailing Address - Phone:502-458-8549
Mailing Address - Fax:502-409-6931
Practice Address - Street 1:2032 ALTA AVE
Practice Address - Street 2:#1
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1102
Practice Address - Country:US
Practice Address - Phone:502-458-8549
Practice Address - Fax:502-409-6931
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1059043163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant