Provider Demographics
NPI:1477899144
Name:ENGLISH, SIMONA DISREE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SIMONA
Middle Name:DISREE
Last Name:ENGLISH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:SIMONA
Other - Middle Name:DISREE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:2 SUNNYSIDE DR APT 102A
Mailing Address - Street 2:102A
Mailing Address - City:WAYLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14572-9762
Mailing Address - Country:US
Mailing Address - Phone:585-831-0148
Mailing Address - Fax:
Practice Address - Street 1:2 SUNNYSIDE DR APT 102A
Practice Address - Street 2:102A
Practice Address - City:WAYLAND
Practice Address - State:NY
Practice Address - Zip Code:14572-9762
Practice Address - Country:US
Practice Address - Phone:585-831-0148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255499164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse