Provider Demographics
NPI:1962954610
Name:SIMON, DONNA (RD)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 S WESLEY
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-2392
Mailing Address - Country:US
Mailing Address - Phone:602-909-6811
Mailing Address - Fax:
Practice Address - Street 1:750 E THUNDERBIRD RD
Practice Address - Street 2:SUITE 3
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022
Practice Address - Country:US
Practice Address - Phone:602-674-6220
Practice Address - Fax:602-978-2198
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered