Healthcare Provider Details

I. General information

NPI: 1376135624
Provider Name (Legal Business Name): MICHAEL SIMPSON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 COUNTY RD
NEW LONDON NH
03257-7700
US

IV. Provider business mailing address

60 ALTA BLVD UNIT 308
LEBANON NH
03766-3414
US

V. Phone/Fax

Practice location:
  • Phone: 603-526-2911
  • Fax:
Mailing address:
  • Phone: 918-808-4419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR0132846
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number085497-21
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number085497-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: