MEDICARE: LAUREN RUTH SIMON CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	0024168917	VA
2	367500000X	Certified Registered Nurse Anesthetist	RN652628	PA
3	367500000X	Certified Registered Nurse Anesthetist	RN141405	TN

General Provider Information

NPI Number	:	1205163896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN RUTH SIMON CRNA

Provider Business Mailing Address
First Line	:	4300 LONDONDERRY RD
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17109-5317
Country	:	US
Telephone Number	:	717-782-5118
Fax Number	:	717-782-5854

Provider Business Practice Location Address
First Line	:	4300 LONDONDERRY RD
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17109-5317
Country	:	US
Telephone Number	:	717-782-5118
Fax Number	:	717-782-5854

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2009
Last Update Date	:	01/22/2026

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