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General NPI Number Information
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NPI Number | 1396566030
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Entity Type | Individual
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Provider Name | FRANTZ MERVEILLEUX SIMON
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Gender | Male
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 744 S WEBSTER AVE
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City | GREEN BAY
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State | WI
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Zip | 54301-3505
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Country | US
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Telephone | 920-433-3605
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Fax | 920-433-3589
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Provider Business Mailing Address
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Address Line | 1913 BROWNING RD
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City | MADISON
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State | WI
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Zip | 53704-3003
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Country | US
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Telephone | 920-659-8396
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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 | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | 583-17
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License Number State | WI
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