Healthcare Provider Details

I. General information

NPI: 1508561697
Provider Name (Legal Business Name): JENNALEE DANIELLE SIMON AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6480 ROCKSIDE WOODS BLVD S STE 330
INDEPENDENCE OH
44131-2222
US

IV. Provider business mailing address

225 W WASHINGTON ST STE 1700
CHICAGO IL
60606-3404
US

V. Phone/Fax

Practice location:
  • Phone: 855-490-9434
  • Fax:
Mailing address:
  • Phone: 855-490-9434
  • Fax: 216-238-9526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.0032589
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.0032589
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: