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General NPI Number Information
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NPI Number | 1114643822
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Entity Type | Individual
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Provider Name | MARISSA RAE SIMON NP
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Gender | Female
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Dates
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Enumeration Date | 10/13/2022
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 633 3RD AVE RM 9B
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City | NEW YORK
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State | NY
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Zip | 10017-0091
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Country | US
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Telephone | 720-666-4739
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Fax |
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Provider Business Mailing Address
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Address Line | 9110 E NICHOLS AVE STE 150
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City | CENTENNIAL
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State | CO
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Zip | 80112-3450
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Country | US
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Telephone | 720-666-4739
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP500018563
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | LP-0010943
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License Number State | DE
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F310799-01
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1142299
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ15066200
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License Number State | NJ
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R266020
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License Number State | MD
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