MEDICARE: MS. FAITH SUSAN SIMON FNP

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	363L00000X	Nurse Practitioner	10815	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00872334	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	RN422135	OTHER	CA	LICENSE NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	NPF10815	OTHER	CA	LICENSE NUMBER

General Provider Information

NPI Number	:	1427078245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. FAITH SUSAN SIMON FNP

Provider Business Mailing Address
First Line	:	PO BOX 38
Second Line	:
City	:	MENDOCINO
State	:	CA
Zip	:	95460
Country	:	US
Telephone Number	:	707-937-1055
Fax Number	:	707-937-1061

Provider Business Practice Location Address
First Line	:	45081 LITTLE LAKE STREET
Second Line	:
City	:	MENDOCINO
State	:	CA
Zip	:	95460
Country	:	US
Telephone Number	:	707-937-1055
Fax Number	:	707-937-1061

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	02/07/2012

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