Provider Demographics
NPI:1417277666
Name:SIMMS, CYNTHIA ICEMA (LPN)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ICEMA
Last Name:SIMMS
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 1:710 EUCLID AVE
Mailing Address - Street 2:APT 6-A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-4548
Mailing Address - Country:US
Mailing Address - Phone:718-277-2246
Mailing Address - Fax:
Practice Address - Street 1:710 EUCLID AVE
Practice Address - Street 2:APT 6-A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-4548
Practice Address - Country:US
Practice Address - Phone:718-277-2246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260101-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse