Provider Demographics
NPI:1619494416
Name:SIMPSON, ROBIN ELAINE (RN)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:ELAINE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:IL
Mailing Address - Zip Code:61530-1182
Mailing Address - Country:US
Mailing Address - Phone:309-467-5254
Mailing Address - Fax:309-467-5303
Practice Address - Street 1:120 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:IL
Practice Address - Zip Code:61530-1182
Practice Address - Country:US
Practice Address - Phone:309-467-5254
Practice Address - Fax:309-467-5303
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000488163WC0400X, 163WC1500X, 163WI0500X, 163WW0000X, 164W00000X, 374U00000X, 376K00000X, 163WH0200X
IL3001272372600000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3001272OtherILLINOIS DEPT OF PUBLIC HEALTH
IL041.280569OtherILLINOIS DEPT OF FINANCIAL AND PROFESSIONAL REGULATION
IL4000488OtherILLINOIS DEPT OF PUBLIC HEALTH
IL2016-N1329OtherDEPT OF LABOR