Provider Demographics
NPI:1700468550
Name:SIMONDS, STEPHANIE D (LPN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:SIMONDS
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 1:7540 HIGHWAY 64 W
Mailing Address - Street 2:
Mailing Address - City:BRASSTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28902-8079
Mailing Address - Country:US
Mailing Address - Phone:828-837-5335
Mailing Address - Fax:828-604-7030
Practice Address - Street 1:7540 HIGHWAY 64 W
Practice Address - Street 2:
Practice Address - City:BRASSTOWN
Practice Address - State:NC
Practice Address - Zip Code:28902-8079
Practice Address - Country:US
Practice Address - Phone:828-837-5335
Practice Address - Fax:828-604-7030
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN071964164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty