Provider Demographics
NPI:1942961115
Name:SIMKO, LAURIE ANN (RN)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:SIMKO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-0249
Mailing Address - Country:US
Mailing Address - Phone:269-657-5574
Mailing Address - Fax:
Practice Address - Street 1:61899 M 43
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:MI
Practice Address - Zip Code:49013-9621
Practice Address - Country:US
Practice Address - Phone:269-427-5671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704222904163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse