Provider Demographics
NPI:1336979285
Name:SIMMONS, BRENDA EARLE (LPN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:EARLE
Last Name:SIMMONS
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 1:301 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-2343
Mailing Address - Country:US
Mailing Address - Phone:864-984-3568
Mailing Address - Fax:864-984-8100
Practice Address - Street 1:301 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-2343
Practice Address - Country:US
Practice Address - Phone:864-984-3568
Practice Address - Fax:864-984-8100
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22828164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse