Provider Demographics
NPI:1386222487
Name:SIMONE, CHRISTINE RENEE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:RENEE
Last Name:SIMONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 PECK HILL RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-4511
Mailing Address - Country:US
Mailing Address - Phone:401-286-1847
Mailing Address - Fax:
Practice Address - Street 1:70 PECK HILL RD
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-4511
Practice Address - Country:US
Practice Address - Phone:401-286-1847
Practice Address - Fax:401-340-1712
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN02806363LF0000X, 363LF0000X
FLAPRN11014508363LF0000X
MARN2336932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily