Healthcare Provider Details

I. General information

NPI: 1811185036
Provider Name (Legal Business Name): NINA S. SIMON DNP,CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 UNSER BLVD SE STE 28400
RIO RANCHO NM
87124-3392
US

IV. Provider business mailing address

2400 UNSER BLVD SE STE 28400
RIO RANCHO NM
87124-3392
US

V. Phone/Fax

Practice location:
  • Phone: 505-253-3000
  • Fax: 505-253-3001
Mailing address:
  • Phone: 505-253-3000
  • Fax: 505-253-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number563
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number563
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: