Healthcare Provider Details

I. General information

NPI: 1619629565
Provider Name (Legal Business Name): SIMONE WAFER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 W CARO RD
CARO MI
48723-9686
US

IV. Provider business mailing address

1525 W CARO RD
CARO MI
48723-9686
US

V. Phone/Fax

Practice location:
  • Phone: 989-672-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2211065406
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: