Provider Demographics
NPI:1275105868
Name:SIMMONS, MAENA (LPN)
Entity Type:Individual
Prefix:
First Name:MAENA
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 1:108 S BRAGG ST
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27589-2048
Mailing Address - Country:US
Mailing Address - Phone:828-655-2939
Mailing Address - Fax:252-879-0073
Practice Address - Street 1:108 S BRAGG ST
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:NC
Practice Address - Zip Code:27589-2048
Practice Address - Country:US
Practice Address - Phone:828-655-2939
Practice Address - Fax:252-879-0073
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC83972164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse