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NPI Code Detail

MEDICARE: RANDI MICHELLE SIMON LPN

MEDICARE: RANDI MICHELLE SIMON LPN
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
1164W00000XLicensed Practical Nurse155090OH

General Provider Information

NPI Number : 1720528292
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDI MICHELLE SIMON LPN
Provider Business Mailing Address
First Line : 1029 JEFFERSON CHASE WAY
Second Line :
City : BLACKLICK
State : OH
Zip : 43004-9156
Country : US
Telephone Number : 614-307-4671
Fax Number :
Provider Business Practice Location Address
First Line : 2065 STONERIDGE DR
Second Line :
City : CIRCLEVILLE
State : OH
Zip : 43113-8956
Country : US
Telephone Number : 740-500-1391
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2017
Last Update Date : 11/17/2023

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Directions to “ RANDI MICHELLE SIMON LPN” Practice Location

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