MEDICARE: ADELLE SIMON

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	49899	WY

General Provider Information

NPI Number	:	1841155967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADELLE SIMON

Provider Business Mailing Address
First Line	:	14 WINDY RIDGE RD
Second Line	:
City	:	LANDER
State	:	WY
Zip	:	82520-9452
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 WINDY RIDGE RD
Second Line	:
City	:	LANDER
State	:	WY
Zip	:	82520-9452
Country	:	US
Telephone Number	:	307-840-1033
Fax Number	:

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

Provider Enumeration Date	:	12/20/2025
Last Update Date	:	12/20/2025

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Directions to “ ADELLE SIMON ” Practice Location

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