Provider Demographics
NPI:1982805438
Name:SIMMONS, CHASSIDY L (LPN)
Entity Type:Individual
Prefix:MISS
First Name:CHASSIDY
Middle Name:L
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 1:8237 LAKESHORE CIRLCE
Mailing Address - Street 2:APT 4413
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250
Mailing Address - Country:US
Mailing Address - Phone:317-508-5943
Mailing Address - Fax:
Practice Address - Street 1:8060 KNEU ROAD
Practice Address - Street 2:GENERAL HEALTHCARE SUITE 110
Practice Address - City:INDIANPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250
Practice Address - Country:US
Practice Address - Phone:317-842-5073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27045130A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse