Provider Demographics
NPI:1508505348
Name:SIMMONS, JANE W (LVN)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:W
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 ELKHORN BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-3502
Mailing Address - Country:US
Mailing Address - Phone:916-459-0025
Mailing Address - Fax:
Practice Address - Street 1:4111 ELKHORN BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-3502
Practice Address - Country:US
Practice Address - Phone:916-459-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN288145164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty