Provider Demographics
NPI:1396851671
Name:SIMON, JANICE MARIE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:MARIE
Last Name:SIMON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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 852
Mailing Address - Street 2:534 5TH ST
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513
Mailing Address - Country:US
Mailing Address - Phone:970-532-0651
Mailing Address - Fax:
Practice Address - Street 1:825 S SHIELDS ST
Practice Address - Street 2:PPRM
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-3590
Practice Address - Country:US
Practice Address - Phone:970-493-0281
Practice Address - Fax:970-493-0729
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO109098363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07109093Medicaid