Provider Demographics
NPI:1407194525
Name:SIMPSON, BLOSSOM (LPN)
Entity Type:Individual
Prefix:MISS
First Name:BLOSSOM
Middle Name:
Last Name:SIMPSON
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 1:801 TILDEN ST
Mailing Address - Street 2:APT. 7C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-6026
Mailing Address - Country:US
Mailing Address - Phone:917-331-3569
Mailing Address - Fax:
Practice Address - Street 1:801 TILDEN ST
Practice Address - Street 2:APT. 7C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-6026
Practice Address - Country:US
Practice Address - Phone:917-331-3569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310395-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse