MEDICARE: MS. PEGGY SIMONS

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	164W00000X	Licensed Practical Nurse	165343	OH

General Provider Information

NPI Number	:	1790204089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PEGGY SIMONS

Provider Business Mailing Address
First Line	:	PO BOX 91010
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43209-7010
Country	:	US
Telephone Number	:	614-218-3925
Fax Number	:

Provider Business Practice Location Address
First Line	:	1484 STRIEBEL RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-2708
Country	:	US
Telephone Number	:	614-218-3925
Fax Number	:

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

Provider Enumeration Date	:	09/18/2017
Last Update Date	:	09/18/2017

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