Healthcare Provider Details

I. General information

NPI: 1407674807
Provider Name (Legal Business Name): SIMONE BRINAE LITES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 05/18/2025
Certification Date: 05/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW # M2210
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

425 SOUTHCROFT RD
SPRINGFIELD PA
19064-1325
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-8541
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG07240171
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: