Provider Demographics
NPI:1992690010
Name:SIMON, JAYME J (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:JAYME
Middle Name:J
Last Name:SIMON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13398 N 148TH AVE
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-4255
Mailing Address - Country:US
Mailing Address - Phone:402-560-5813
Mailing Address - Fax:
Practice Address - Street 1:13398 N 148TH AVE
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-4255
Practice Address - Country:US
Practice Address - Phone:402-560-5813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL-316437163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant