Healthcare Provider Details

I. General information

NPI: 1215378815
Provider Name (Legal Business Name): LAUREN JEANETTE SIMONE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR STE 220B
BEVERLY MA
01915-6113
US

IV. Provider business mailing address

100 CUMMINGS CTR STE 220B
BEVERLY MA
01915-6113
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-9824
  • Fax: 978-922-5904
Mailing address:
  • Phone: 978-927-9824
  • Fax: 978-922-5904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN273979
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN273979
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: