MEDICARE: MRS. HEATHER SIMONE

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	363A00000X	Physician Assistant	15614	MN

General Provider Information

NPI Number	:	1912630369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER SIMONE

Provider Business Mailing Address
First Line	:	915 E 1ST ST
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55805-2107
Country	:	US
Telephone Number	:	218-340-7483
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 E 3RD ST
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55804-1813
Country	:	US
Telephone Number	:	218-340-7483
Fax Number	:

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

Provider Enumeration Date	:	07/05/2022
Last Update Date	:	12/10/2025

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Directions to “ MRS. HEATHER SIMONE ” Practice Location

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