Provider Demographics
NPI:1396224523
Name:SIMMONS, LUANN (BSN, RN)
Entity Type:Individual
Prefix:
First Name:LUANN
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SUFFOLK DOWN
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-1538
Mailing Address - Country:US
Mailing Address - Phone:631-664-7535
Mailing Address - Fax:
Practice Address - Street 1:30 SUFFOLK DOWN
Practice Address - Street 2:
Practice Address - City:SHOREHAM
Practice Address - State:NY
Practice Address - Zip Code:11786-1538
Practice Address - Country:US
Practice Address - Phone:631-664-7535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY702790-1163WH0500X, 163WI0500X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy