Provider Demographics
NPI:1932151412
Name:SIMPSON, NICOLE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANN
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 S 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4816
Mailing Address - Country:US
Mailing Address - Phone:715-298-0858
Mailing Address - Fax:
Practice Address - Street 1:2500 BERNVILLE RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-9453
Practice Address - Country:US
Practice Address - Phone:610-378-2055
Practice Address - Fax:610-378-2058
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48265-020207L00000X
PAMD485576207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34692300Medicaid
WII47015Medicare UPIN
WI34692300Medicaid