Healthcare Provider Details

I. General information

NPI: 1093913964
Provider Name (Legal Business Name): LINDA SUSANNA SIMONIS LINDA SIMONIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDA SUSANNA SIMONIS LINDA SIMONIS RN,

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2032 ALTA AVE #1
LOUISVILLE KY
40205-1102
US

IV. Provider business mailing address

2032 ALTA AVE #1
LOUISVILLE KY
40205-1102
US

V. Phone/Fax

Practice location:
  • Phone: 502-458-8549
  • Fax: 502-409-6931
Mailing address:
  • Phone: 502-458-8549
  • Fax: 502-409-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number1059043
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: