Provider Demographics
NPI:1417434598
Name:SIMONSON, CLARISSA M (DNP, AGNP-C, APNP)
Entity Type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:M
Last Name:SIMONSON
Suffix:
Gender:F
Credentials:DNP, AGNP-C, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-3112
Mailing Address - Country:US
Mailing Address - Phone:715-207-1419
Mailing Address - Fax:
Practice Address - Street 1:6516 CAMERON AVE
Practice Address - Street 2:
Practice Address - City:VESPER
Practice Address - State:WI
Practice Address - Zip Code:54489-9404
Practice Address - Country:US
Practice Address - Phone:715-207-1419
Practice Address - Fax:877-860-4676
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8515363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner