Provider Demographics
NPI:1255092649
Name:SIMMONDS, REBECCA LYNNE (LPN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNNE
Last Name:SIMMONDS
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 1:5 CAYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-1021
Mailing Address - Country:US
Mailing Address - Phone:845-380-4066
Mailing Address - Fax:
Practice Address - Street 1:5 CAYWOOD RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-1021
Practice Address - Country:US
Practice Address - Phone:845-380-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322851-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY322851OtherPEDIATRIC ADVANCED LIFE SUPPORT (PALS), AMERICAN HEART ASSOCIATION - AAP
NY322851-01OtherLICENSED PRACTICAL NURSE/PEDIATRICS
NY322851-01OtherLICENSED PRACTICAL NURSE/HOME CARE