Provider Demographics
NPI:1689969511
Name:SIMONETTI, VIRGINIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:
Last Name:SIMONETTI
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 1:515 LIBERTY CAP CT
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-8722
Mailing Address - Country:US
Mailing Address - Phone:970-245-3229
Mailing Address - Fax:
Practice Address - Street 1:510 29 1/2 RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-5383
Practice Address - Country:US
Practice Address - Phone:970-248-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27531163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health