Provider Demographics
NPI:1407195985
Name:SIMPSON, PHILOMINA
Entity Type:Individual
Prefix:MRS
First Name:PHILOMINA
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PHILOMINA
Other - Middle Name:E
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8605 BELGROVE GARDENS LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-5879
Mailing Address - Country:US
Mailing Address - Phone:703-754-0157
Mailing Address - Fax:
Practice Address - Street 1:8605 BELGROVE GARDENS LN
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-5879
Practice Address - Country:US
Practice Address - Phone:703-754-0157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001157891163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAMEDICAIDMedicaid