Provider Demographics
NPI:1164792727
Name:SIMOVIC, STEPHANY L
Entity Type:Individual
Prefix:MISS
First Name:STEPHANY
Middle Name:L
Last Name:SIMOVIC
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 1:6824 LALEMANT DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5402
Mailing Address - Country:US
Mailing Address - Phone:440-840-1192
Mailing Address - Fax:
Practice Address - Street 1:8583 N AKINS RD APT 104
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-4762
Practice Address - Country:US
Practice Address - Phone:440-840-1192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.142821-M-IV164W00000X
OHRN.421469163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No164W00000XNursing Service ProvidersLicensed Practical Nurse