MEDICARE: MS. SUSAN K SIMON APNP

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	363L00000X	Nurse Practitioner	47332-030	WI
2	363L00000X	Nurse Practitioner	1313-033	WI

General Provider Information

NPI Number	:	1982711180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN K SIMON APNP

Provider Business Mailing Address
First Line	:	3301 W FOREST HOME AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-2843
Country	:	US
Telephone Number	:	414-647-6326
Fax Number	:	414-671-8860

Provider Business Practice Location Address
First Line	:	1020 N 12TH ST
Second Line	:	3RD FLOOR
City	:	MILWAUKEE
State	:	WI
Zip	:	53233
Country	:	US
Telephone Number	:	414-219-7300
Fax Number	:	414-219-7632

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	03/08/2026

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