Healthcare Provider Details

I. General information

NPI: 1750809422
Provider Name (Legal Business Name): A SIMON BIRTH ASSISTING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 09/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14502 W MEEKER BLVD
SUN CITY WEST AZ
85375-5282
US

IV. Provider business mailing address

8045 W TONOPAH DR
PEORIA AZ
85382-5431
US

V. Phone/Fax

Practice location:
  • Phone: 602-818-7193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP7987
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP7653
License Number StateAZ

VIII. Authorized Official

Name: AMANDA SIMON
Title or Position: CNM, WHNP-BC
Credential: CNM, WHNP-BC
Phone: 602-818-7193