Healthcare Provider Details

I. General information

NPI: 1649801275
Provider Name (Legal Business Name): SONYA ELIZABETH SIMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2020
Last Update Date: 02/02/2020
Certification Date: 02/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 ELECTRIC AVENUE
PORT HURON MI
48060-8127
US

IV. Provider business mailing address

7693 SPARLING RD
WALES MI
48027-2112
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-8900
  • Fax:
Mailing address:
  • Phone: 810-242-9849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: