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General NPI Number Information
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NPI Number | 1063830792
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Entity Type | Individual
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Provider Name | MICHAEL SIMONS CRNA
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Gender | Male
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 176 DENISON PKWY E
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City | CORNING
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State | NY
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Zip | 14830-2814
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Country | US
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Telephone | 607-937-7278
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Fax |
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Provider Business Mailing Address
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Address Line | 1 GUTHRIE SQ
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City | SAYRE
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State | PA
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Zip | 18840-1625
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Country | US
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Telephone | 570-888-5858
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN632747
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 630215
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License Number State | NY
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