Provider Demographics
NPI:1659671626
Name:SIMEUS, MINDY (LPN)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:SIMEUS
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 1:14 ROBERT AREY DRIVE
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368
Mailing Address - Country:US
Mailing Address - Phone:617-980-2403
Mailing Address - Fax:
Practice Address - Street 1:15 ROBERT AREY DR
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3742
Practice Address - Country:US
Practice Address - Phone:617-980-2403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA69922164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse