1063897809 NPI number — MRS. RIANNON LYNN SIMMERMAN LIMHP, PLADC

Table of content: MRS. RIANNON LYNN SIMMERMAN LIMHP, PLADC (NPI 1063897809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063897809 NPI number — MRS. RIANNON LYNN SIMMERMAN LIMHP, PLADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMMERMAN
Provider First Name:
RIANNON
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LIMHP, PLADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JEFFERY
Provider Other First Name:
RIANNON
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PLMHP, PLADC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063897809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11920 BURT STREET
Provider Second Line Business Mailing Address:
SUITE 190
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-965-4004
Provider Business Mailing Address Fax Number:
402-965-4232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11920 BURT STREET
Provider Second Line Business Practice Location Address:
SUITE 190
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-965-4004
Provider Business Practice Location Address Fax Number:
402-965-4232
Provider Enumeration Date:
07/22/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  2049 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: P-1334 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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