Healthcare Provider Details

I. General information

NPI: 1396851671
Provider Name (Legal Business Name): JANICE MARIE SIMON NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 S SHIELDS ST PPRM
FORT COLLINS CO
80521-3590
US

IV. Provider business mailing address

PO BOX 852 534 5TH ST
BERTHOUD CO
80513
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-0281
  • Fax: 970-493-0729
Mailing address:
  • Phone: 970-532-0651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number109098
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: