1063951572 NPI number — MRS. STACEY RENEE SIMON APRN-CNP

Table of content: MRS. STACEY RENEE SIMON APRN-CNP (NPI 1063951572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063951572 NPI number — MRS. STACEY RENEE SIMON APRN-CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMON
Provider First Name:
STACEY
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN-CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPICER
Provider Other First Name:
STACEY
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN-CNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063951572
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4040 EMBASSY PKWY
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44333-8326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-576-4295
Provider Business Mailing Address Fax Number:
330-576-0468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4040 EMBASSY PKWY
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44333-8326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-576-4295
Provider Business Practice Location Address Fax Number:
330-576-0468
Provider Enumeration Date:
02/16/2017

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: 363LF0000X , with the licence number:  APRN.CNP.020245 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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