Provider Demographics
NPI:1487222618
Name:SIMPSON, LARA MARY (LPN)
Entity Type:Individual
Prefix:MISS
First Name:LARA
Middle Name:MARY
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 1:1102 W 3RD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-2307
Mailing Address - Country:US
Mailing Address - Phone:218-591-5214
Mailing Address - Fax:
Practice Address - Street 1:1102 W 3RD ST APT 2
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-2307
Practice Address - Country:US
Practice Address - Phone:218-591-5214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN818862164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse