Healthcare Provider Details

I. General information

NPI: 1508576695
Provider Name (Legal Business Name): PARIS GENINE SIMONO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PARIS G GUMINIK

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 JACKSON RD STE 100
ANN ARBOR MI
48103-1889
US

IV. Provider business mailing address

22255 BROOKFIELD DR
SOUTH LYON MI
48178-1595
US

V. Phone/Fax

Practice location:
  • Phone: 734-971-9344
  • Fax: 734-971-2303
Mailing address:
  • Phone: 248-497-8375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number4704342323
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704342323
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: