Provider Demographics
NPI:1174826903
Name:SIMERMAN, JENNIFER L (LPN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:SIMERMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:ADKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:317 30TH ST APT 105D
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-5876
Mailing Address - Country:US
Mailing Address - Phone:480-229-4090
Mailing Address - Fax:
Practice Address - Street 1:317 30TH ST APT 105D
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-5876
Practice Address - Country:US
Practice Address - Phone:480-229-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201030479LPN164W00000X
CA235467164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse