Provider Demographics
NPI:1104375922
Name:SIMON, NELLIE (ARNP)
Entity Type:Individual
Prefix:
First Name:NELLIE
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:NELLIE
Other - Middle Name:GRACE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-226-0112
Mailing Address - Fax:515-223-0422
Practice Address - Street 1:1525 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-3412
Practice Address - Country:US
Practice Address - Phone:515-226-0112
Practice Address - Fax:515-223-0422
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA143864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily