Provider Demographics
NPI:1235409426
Name:SIMON, SHARON E (CNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:E
Last Name:SIMON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-1460
Mailing Address - Country:US
Mailing Address - Phone:605-622-2857
Mailing Address - Fax:605-622-2859
Practice Address - Street 1:8 E US HIGHWAY 12
Practice Address - Street 2:SUITE 2
Practice Address - City:GROTON
Practice Address - State:SD
Practice Address - Zip Code:57445-2176
Practice Address - Country:US
Practice Address - Phone:605-397-4242
Practice Address - Fax:605-397-4243
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000691363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner