Provider Demographics
NPI:1295400273
Name:SIMMS, CHARLENE (LPN)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:SIMMS
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 1:128 W HIGH ST # 2
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:MA
Mailing Address - Zip Code:02322-1266
Mailing Address - Country:US
Mailing Address - Phone:617-750-9442
Mailing Address - Fax:
Practice Address - Street 1:23 BRADSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2703
Practice Address - Country:US
Practice Address - Phone:617-318-6480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN90877163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)