Provider Demographics
NPI:1104590645
Name:MAGNE SIMO, CHRISTINE F
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:F
Last Name:MAGNE SIMO
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 1:702 CHILLUM RD APT 201
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-6371
Mailing Address - Country:US
Mailing Address - Phone:240-645-2118
Mailing Address - Fax:
Practice Address - Street 1:702 CHILLUM RD APT 201
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-6371
Practice Address - Country:US
Practice Address - Phone:240-645-2118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCNA20212385376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide