Provider Demographics
NPI:1508576695
Name:SIMONO, PARIS GENINE (CNP)
Entity Type:Individual
Prefix:
First Name:PARIS
Middle Name:GENINE
Last Name:SIMONO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:PARIS
Other - Middle Name:G
Other - Last Name:GUMINIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22255 BROOKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-1595
Mailing Address - Country:US
Mailing Address - Phone:248-497-8375
Mailing Address - Fax:
Practice Address - Street 1:4350 JACKSON RD STE 100
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1889
Practice Address - Country:US
Practice Address - Phone:734-971-9344
Practice Address - Fax:734-971-2303
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704342323163WP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics