Provider Demographics
NPI:1023247574
Name:SIMOVIC, ADRIANE STANA (LPN)
Entity type:Individual
Prefix:MS
First Name:ADRIANE
Middle Name:STANA
Last Name:SIMOVIC
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 1:4004 HENRITZE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-3252
Mailing Address - Country:US
Mailing Address - Phone:216-661-8032
Mailing Address - Fax:
Practice Address - Street 1:4004 HENRITZE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-3252
Practice Address - Country:US
Practice Address - Phone:216-661-8032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 128075 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse