Healthcare Provider Details

I. General information

NPI: 1831638212
Provider Name (Legal Business Name): SARAH SIMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH TYLER APNP

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7793 W APPLETON AVE
MILWAUKEE WI
53222-2009
US

IV. Provider business mailing address

335 E MAHN CT
OAK CREEK WI
53154-2155
US

V. Phone/Fax

Practice location:
  • Phone: 414-393-9810
  • Fax: 414-393-9817
Mailing address:
  • Phone: 414-762-2020
  • Fax: 414-762-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7544-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7544-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: