Provider Demographics
NPI:1245591312
Name:SIMONS, BRIAN M (RN)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:SIMONS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7222 S COUNTY RD E
Mailing Address - Street 2:
Mailing Address - City:SOLON SPRINGS
Mailing Address - State:WI
Mailing Address - Zip Code:54873-8297
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7222 S COUNTY RD E
Practice Address - Street 2:
Practice Address - City:SOLON SPRINGS
Practice Address - State:WI
Practice Address - Zip Code:54873-8297
Practice Address - Country:US
Practice Address - Phone:715-817-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 199881-0163W00000X, 163WA0400X, 163WC0200X, 163WC0400X, 163WG0000X, 163WH0200X, 163WP0200X, 163WP0808X
MNR199881-0163WA2000X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult