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General NPI Number Information
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NPI Number | 1174826903
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Entity Type | Individual
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Provider Name | JENNIFER L SIMERMAN LPN
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Gender | Female
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Dates
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Enumeration Date | 12/16/2010
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Last Update Date | 12/16/2010
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Provider Practice Location Address
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Address Line | 317 30TH ST APT 105D
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City | SPRINGFIELD
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State | OR
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Zip | 97478-5876
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Country | US
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Telephone | 480-229-4090
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Fax |
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Provider Business Mailing Address
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Address Line | 317 30TH ST APT 105D
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City | SPRINGFIELD
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State | OR
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Zip | 97478-5876
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Country | US
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Telephone | 480-229-4090
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 201030479LPN
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 235467
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License Number State | CA
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