Provider Demographics
NPI:1316764673
Name:EPIEWANE, SIMON EWANE (LPN)
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:EWANE
Last Name:EPIEWANE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 NORTHDOWN DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-9756
Mailing Address - Country:US
Mailing Address - Phone:302-399-3397
Mailing Address - Fax:
Practice Address - Street 1:210 NORTHDOWN DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-9756
Practice Address - Country:US
Practice Address - Phone:302-399-3397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2024942032374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide