Healthcare Provider Details

I. General information

NPI: 1962272385
Provider Name (Legal Business Name): ELIZABETH SIMCOX NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 CLEVELAND AVE
STEVENSVILLE MI
49127-9670
US

IV. Provider business mailing address

5515 CLEVELAND AVE
STEVENSVILLE MI
49127-9670
US

V. Phone/Fax

Practice location:
  • Phone: 269-429-9644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704286321
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: