Provider Demographics
NPI:1942734876
Name:SIMMONS, MAURICE (LVN)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 HOLLAND AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-6573
Mailing Address - Country:US
Mailing Address - Phone:469-245-6861
Mailing Address - Fax:214-818-0345
Practice Address - Street 1:5008 HOLLAND AVE APT 16
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-6573
Practice Address - Country:US
Practice Address - Phone:469-245-6861
Practice Address - Fax:214-818-0345
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide