Provider Demographics
NPI:1881060911
Name:SIMON, ANNETTE COLLEEN (LPN)
Entity type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:COLLEEN
Last Name:SIMON
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 1:27 W 129TH ST
Mailing Address - Street 2:2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-2200
Mailing Address - Country:US
Mailing Address - Phone:917-385-0199
Mailing Address - Fax:718-794-1350
Practice Address - Street 1:27 W 129TH ST
Practice Address - Street 2:2B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-2200
Practice Address - Country:US
Practice Address - Phone:917-385-0199
Practice Address - Fax:718-794-1350
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3106861164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse