Provider Demographics
NPI:1497270110
Name:SIMON, GUILLANA (MSN FNP-BC, RN, CEN)
Entity Type:Individual
Prefix:
First Name:GUILLANA
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:MSN FNP-BC, RN, CEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11186 SEWICKLEY ST
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2688
Mailing Address - Country:US
Mailing Address - Phone:240-222-2667
Mailing Address - Fax:
Practice Address - Street 1:22590 SHADY CT
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-5009
Practice Address - Country:US
Practice Address - Phone:301-737-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR152798363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily