Provider Demographics
NPI:1922324227
Name:SIMMONS-OWEN, WENDE SUE (LVN/LPN)
Entity Type:Individual
Prefix:MS
First Name:WENDE
Middle Name:SUE
Last Name:SIMMONS-OWEN
Suffix:
Gender:F
Credentials:LVN/LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SIERRA WOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:GASQUET
Mailing Address - State:CA
Mailing Address - Zip Code:95543
Mailing Address - Country:US
Mailing Address - Phone:707-954-3961
Mailing Address - Fax:707-954-3961
Practice Address - Street 1:301 SIERRA WOOD ROAD
Practice Address - Street 2:
Practice Address - City:GASQUET
Practice Address - State:CA
Practice Address - Zip Code:95543
Practice Address - Country:US
Practice Address - Phone:707-954-3961
Practice Address - Fax:707-954-3961
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN195156164X00000X
CA200330237LPN164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse