Provider Demographics
NPI:1417788571
Name:SIMERL, TANYA MARIE
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:MARIE
Last Name:SIMERL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11060 W JANESVILLE RD APT 4
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-2544
Mailing Address - Country:US
Mailing Address - Phone:808-793-8284
Mailing Address - Fax:
Practice Address - Street 1:11060 W JANESVILLE RD APT 4
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2544
Practice Address - Country:US
Practice Address - Phone:808-793-8284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2052-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist