MEDICARE: MS. SANDRA ELLEN SIMMONS LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	17150	NV

General Provider Information

NPI Number	:	1184494270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA ELLEN SIMMONS LPN

Provider Business Mailing Address
First Line	:	10192 S MARYLAND PKWY APT 1012
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7332
Country	:	US
Telephone Number	:	702-761-0472
Fax Number	:

Provider Business Practice Location Address
First Line	:	10192 S MARYLAND PKWY APT 1012
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7332
Country	:	US
Telephone Number	:	702-761-0472
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/09/2024

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