Provider Demographics
NPI:1679254189
Name:SIMMONS, JANNIE RICHEAL
Entity type:Individual
Prefix:
First Name:JANNIE
Middle Name:RICHEAL
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 1ST ST SE APT 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-2824
Mailing Address - Country:US
Mailing Address - Phone:202-440-6249
Mailing Address - Fax:
Practice Address - Street 1:331 N ST NE APT 210
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7394
Practice Address - Country:US
Practice Address - Phone:202-840-2748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant