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General NPI Number Information
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NPI Number | 1851110498
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Entity Type | Individual
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Provider Name | SIMONE MARJORIE BAZILE PMHNP
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Gender | Female
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 145 HOLLIS ST
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City | MANCHESTER
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State | NH
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Zip | 03101-1235
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Country | US
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Telephone | 617-839-5029
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Fax |
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Provider Business Mailing Address
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Address Line | 321 CHICOPEE ROW
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City | GROTON
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State | MA
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Zip | 01450-1463
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Country | US
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Telephone | 617-839-5029
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 13878
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 112965-23
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License Number State | NH
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