Healthcare Provider Details

I. General information

NPI: 1801978861
Provider Name (Legal Business Name): MICHAEL SIMPSON FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31292 ALPINE MEADOWS RD
SHINGLETOWN CA
96088-9462
US

IV. Provider business mailing address

31292 ALPINE MEADOWS RD
SHINGLETOWN CA
96088-9462
US

V. Phone/Fax

Practice location:
  • Phone: 530-474-3390
  • Fax:
Mailing address:
  • Phone: 530-474-3390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP5849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: