Provider Demographics
NPI:1437310638
Name:SIMMONDS, CARLENE JUNE (LPN)
Entity Type:Individual
Prefix:
First Name:CARLENE
Middle Name:JUNE
Last Name:SIMMONDS
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 1:34 WINDING LN
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-6145
Mailing Address - Country:US
Mailing Address - Phone:631-273-3049
Mailing Address - Fax:
Practice Address - Street 1:34 WINDING LN
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-6145
Practice Address - Country:US
Practice Address - Phone:631-273-3049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2686621313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility