MEDICARE: ANNA SIMONENKO PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	841368	NV

General Provider Information

NPI Number	:	1891539011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA SIMONENKO PMHNP-BC

Provider Business Mailing Address
First Line	:	9500 HILLWOOD DR STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-0525
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 HILLWOOD DR STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-0525
Country	:	US
Telephone Number	:	725-208-3309
Fax Number	:

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

Provider Enumeration Date	:	06/21/2024
Last Update Date	:	06/21/2024

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