Provider Demographics
NPI:1336534890
Name:SIMMONS, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12880 DOLSON ST
Mailing Address - Street 2:# 106
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-3297
Mailing Address - Country:US
Mailing Address - Phone:313-693-4258
Mailing Address - Fax:
Practice Address - Street 1:12880 DOLSON ST
Practice Address - Street 2:# 106
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-3297
Practice Address - Country:US
Practice Address - Phone:313-693-4258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider