Healthcare Provider Details

I. General information

NPI: 1508653726
Provider Name (Legal Business Name): JENNIFER SIMON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4242 FARNAM ST STE 650
OMAHA NE
68131-2813
US

IV. Provider business mailing address

1652 N 174TH ST
OMAHA NE
68118-2891
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-8600
  • Fax:
Mailing address:
  • Phone: 307-287-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number29473
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: