Provider Demographics
NPI:1528734092
Name:SIMONI, SUSAN JANE
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANE
Last Name:SIMONI
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 1:7653 CORRECTIONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:IA
Mailing Address - Zip Code:51030-8080
Mailing Address - Country:US
Mailing Address - Phone:712-898-8135
Mailing Address - Fax:712-224-4302
Practice Address - Street 1:7653 CORRECTIONVILLE RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:IA
Practice Address - Zip Code:51030-8080
Practice Address - Country:US
Practice Address - Phone:712-898-8135
Practice Address - Fax:712-224-4302
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA068289163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse