MEDICARE: MS. DANA MARISA SIMONS R.N.

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	163W00000X	Registered Nurse	647762	NY

General Provider Information

NPI Number	:	1780954529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANA MARISA SIMONS R.N.

Provider Business Mailing Address
First Line	:	16 DAVIS ST
Second Line	:
City	:	LOCUST VALLEY
State	:	NY
Zip	:	11560-1808
Country	:	US
Telephone Number	:	516-661-2565
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 DAVIS ST
Second Line	:
City	:	LOCUST VALLEY
State	:	NY
Zip	:	11560-1808
Country	:	US
Telephone Number	:	516-661-2565
Fax Number	:

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

Provider Enumeration Date	:	01/11/2012
Last Update Date	:	01/11/2012

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