Provider Demographics
NPI:1346804036
Name:MCDANIEL-SIMMONS, TOOSDHI MARQUETTE (PRACTICAL NURSE)
Entity Type:Individual
Prefix:
First Name:TOOSDHI
Middle Name:MARQUETTE
Last Name:MCDANIEL-SIMMONS
Suffix:
Gender:F
Credentials:PRACTICAL NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 AMBERJACK RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-7989
Mailing Address - Country:US
Mailing Address - Phone:973-776-6561
Mailing Address - Fax:
Practice Address - Street 1:3015 AMBERJACK RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-7989
Practice Address - Country:US
Practice Address - Phone:973-776-6561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-28
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC81406164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse