Provider Demographics
NPI:1346819935
Name:SIMPSON, JACQUELINE RENEE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:RENEE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JACKIE
Other - Middle Name:RENEE
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4941 JUST ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-4872
Mailing Address - Country:US
Mailing Address - Phone:202-704-0392
Mailing Address - Fax:
Practice Address - Street 1:5501 BASS PL SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6381
Practice Address - Country:US
Practice Address - Phone:202-583-1285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker