Provider Demographics
NPI:1508561697
Name:SIMON, JENNALEE DANIELLE (AGPCNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNALEE
Middle Name:DANIELLE
Last Name:SIMON
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 W WASHINGTON ST STE 1700
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-3404
Mailing Address - Country:US
Mailing Address - Phone:855-490-9434
Mailing Address - Fax:216-238-9526
Practice Address - Street 1:6480 ROCKSIDE WOODS BLVD S STE 330
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2222
Practice Address - Country:US
Practice Address - Phone:855-490-9434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0032589363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health