Provider Demographics
NPI:1558680546
Name:SIMMONS, LISA WINFORD
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:WINFORD
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:CASSIUS
Other - Middle Name:CLAYTON
Other - Last Name:SIMMONS
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2639 VALENTINE CT
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-5141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2639 VALENTINE CT
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-5141
Practice Address - Country:US
Practice Address - Phone:504-298-7871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-31
Last Update Date:2010-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)