Provider Demographics
NPI:1881001154
Name:SIMMS, EVELYN Y (LVN)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:Y
Last Name:SIMMS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1553
Mailing Address - Country:US
Mailing Address - Phone:510-433-1160
Mailing Address - Fax:510-844-0132
Practice Address - Street 1:510 17TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1553
Practice Address - Country:US
Practice Address - Phone:510-433-1160
Practice Address - Fax:510-844-0132
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN108592164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse