MEDICARE: HOLLY SIMON RDN

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1437990827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY SIMON RDN

Provider Business Mailing Address
First Line	:	34 NEWBURY CIR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53711-3954
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 NEWBURY CIR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53711-3954
Country	:	US
Telephone Number	:	608-294-7615
Fax Number	:

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

Provider Enumeration Date	:	06/01/2024
Last Update Date	:	06/01/2024

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