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General NPI Number Information
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NPI Number | 1558716324
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Entity Type | Individual
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Provider Name | STACY LYNN SIMONS AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/29/2016
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 400 MACK AVE
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City | DETROIT
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State | MI
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Zip | 48201-2136
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Country | US
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Telephone | 877-227-8823
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Fax |
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Provider Business Mailing Address
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Address Line | 2366 OAK VALLEY DR
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City | ANN ARBOR
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State | MI
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Zip | 48103-8944
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Country | US
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Telephone | 734-662-5999
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704244140
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 4704244140
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704244140
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License Number State | MI
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