Provider Demographics
NPI:1447542055
Name:SIMES, TYPHANIE SHAVAUN (LPN)
Entity type:Individual
Prefix:
First Name:TYPHANIE
Middle Name:SHAVAUN
Last Name:SIMES
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 1:4003 FOXBORO DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45416-1624
Mailing Address - Country:US
Mailing Address - Phone:937-469-6208
Mailing Address - Fax:
Practice Address - Street 1:4003 FOXBORO DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45416-1624
Practice Address - Country:US
Practice Address - Phone:937-469-6208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-15
Last Update Date:2011-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140092164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse