Provider Demographics
NPI:1255659884
Name:SIMMONS, LORI (LPN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:SIMMONS
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 1:5 COMPUTER DR W
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1659
Mailing Address - Country:US
Mailing Address - Phone:518-438-6271
Mailing Address - Fax:518-438-3360
Practice Address - Street 1:5 COMPUTER DR W
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1659
Practice Address - Country:US
Practice Address - Phone:518-438-6271
Practice Address - Fax:518-438-3360
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00156297164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00156297OtherLICENSE