Provider Demographics
NPI:1114293503
Name:SIMMONS, BRENDA JULIENNE
Entity Type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:JULIENNE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ASCH LOOP
Mailing Address - Street 2:APT 16G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4033
Mailing Address - Country:US
Mailing Address - Phone:347-204-4133
Mailing Address - Fax:
Practice Address - Street 1:2365 WATERBURY AVE
Practice Address - Street 2:ROOM 2250
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462
Practice Address - Country:US
Practice Address - Phone:347-204-4133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217907-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse