Provider Demographics
NPI:1881230670
Name:SIMON, DE ANNE (CNIM)
Entity Type:Individual
Prefix:MISS
First Name:DE ANNE
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 COMANCHE VISTA TRL
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-5377
Mailing Address - Country:US
Mailing Address - Phone:817-368-1980
Mailing Address - Fax:
Practice Address - Street 1:201 MAIN ST STE 600
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-3110
Practice Address - Country:US
Practice Address - Phone:817-368-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4482OtherCNIM