Healthcare Provider Details

I. General information

NPI: 1487900395
Provider Name (Legal Business Name): BROOK SIMONSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2012
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 GOLDEN VALLEY RD
GOLDEN VALLEY MN
55422-4109
US

IV. Provider business mailing address

4940 GOLDEN VALLEY RD
GOLDEN VALLEY MN
55422-4109
US

V. Phone/Fax

Practice location:
  • Phone: 612-251-1225
  • Fax:
Mailing address:
  • Phone: 612-251-1225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number2487545
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number2487545
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: