MEDICARE: AMBER D SIMM APRN-FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN.CNP0030851	OH

General Provider Information

NPI Number	:	1306583067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER D SIMM APRN-FNP-C

Provider Business Mailing Address
First Line	:	4627 WESTWOOD AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-1914
Country	:	US
Telephone Number	:	740-610-3660
Fax Number	:

Provider Business Practice Location Address
First Line	:	4810 EVERHARD RD NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-2413
Country	:	US
Telephone Number	:	234-360-1388
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2022
Last Update Date	:	05/15/2022

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