Provider Demographics
NPI:1104052034
Name:SIMORA, DAPHANE ANGELA (ND)
Entity type:Individual
Prefix:DR
First Name:DAPHANE
Middle Name:ANGELA
Last Name:SIMORA
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 113
Mailing Address - Street 2:
Mailing Address - City:HERCULANEUM
Mailing Address - State:MO
Mailing Address - Zip Code:63048-0113
Mailing Address - Country:US
Mailing Address - Phone:636-633-2048
Mailing Address - Fax:
Practice Address - Street 1:836 BROWN ST
Practice Address - Street 2:
Practice Address - City:HERCULANEUM
Practice Address - State:MO
Practice Address - Zip Code:63048
Practice Address - Country:US
Practice Address - Phone:636-633-2048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath