Provider Demographics
NPI:1114100633
Name:SIMPKINS, GEORGETTE MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:MARIE
Last Name:SIMPKINS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7134
Mailing Address - Street 2:
Mailing Address - City:NIKISKI
Mailing Address - State:AK
Mailing Address - Zip Code:99635-7134
Mailing Address - Country:US
Mailing Address - Phone:907-776-7651
Mailing Address - Fax:
Practice Address - Street 1:265 N BINKLEY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7523
Practice Address - Country:US
Practice Address - Phone:907-262-6550
Practice Address - Fax:907-262-6572
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK111171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist