Provider Demographics
NPI:1639645369
Name:SIMON, MARY F (ND)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:F
Last Name:SIMON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 N FARWELL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2968
Mailing Address - Country:US
Mailing Address - Phone:414-278-8922
Mailing Address - Fax:
Practice Address - Street 1:1428 N FARWELL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2968
Practice Address - Country:US
Practice Address - Phone:414-278-8922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-20
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath