Provider Demographics
NPI:1720478746
Name:SIMMONS, MELANIE JOAN (LPN)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:JOAN
Last Name:SIMMONS
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 1:98-719 IHO PL
Mailing Address - Street 2:#5-602
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-2515
Mailing Address - Country:US
Mailing Address - Phone:229-848-2770
Mailing Address - Fax:
Practice Address - Street 1:480 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PEARL HARBOR
Practice Address - State:HI
Practice Address - Zip Code:96860-4908
Practice Address - Country:US
Practice Address - Phone:229-848-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN078892164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse