Healthcare Provider Details

I. General information

NPI: 1245591312
Provider Name (Legal Business Name): BRIAN M SIMONS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7222 S COUNTY RD E
SOLON SPRINGS WI
54873-8297
US

IV. Provider business mailing address

7222 S COUNTY RD E
SOLON SPRINGS WI
54873-8297
US

V. Phone/Fax

Practice location:
  • Phone: 715-817-4661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 199881-0
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberR 199881-0
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR 199881-0
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR 199881-0
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR 199881-0
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR 199881-0
License Number StateMN
# 7
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberR 199881-0
License Number StateMN
# 8
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR 199881-0
License Number StateMN
# 9
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberR199881-0
License Number StateMN
# 10
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR199881-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: