Healthcare Provider Details

I. General information

NPI: 1396767463
Provider Name (Legal Business Name): MARY ANN J SIMPSON RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ANN JORDAN

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 LAKE BOONE TRL
RALEIGH NC
27607-7505
US

IV. Provider business mailing address

4420 LAKE BOONE TRL
RALEIGH NC
27607-7505
US

V. Phone/Fax

Practice location:
  • Phone: 919-387-3200
  • Fax: 919-387-3201
Mailing address:
  • Phone: 919-387-3200
  • Fax: 919-387-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberL032445
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: