Provider Demographics
NPI:1215323126
Name:SIMON, JESSICA (RN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1863 DAVID AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-6818
Mailing Address - Country:US
Mailing Address - Phone:440-227-4481
Mailing Address - Fax:
Practice Address - Street 1:1863 DAVID AVE
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-6818
Practice Address - Country:US
Practice Address - Phone:440-227-4481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN376074163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse