Provider Demographics
NPI:1891887428
Name:SIMPAO, LOUELLA PINEDA (MD)
Entity Type:Individual
Prefix:
First Name:LOUELLA
Middle Name:PINEDA
Last Name:SIMPAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 20TH STREET SOUTH
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560
Mailing Address - Country:US
Mailing Address - Phone:218-284-0300
Mailing Address - Fax:218-284-5944
Practice Address - Street 1:2925 20TH ST SOUTH
Practice Address - Street 2:PRAIRIE ST JOHNS
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560
Practice Address - Country:US
Practice Address - Phone:218-284-0300
Practice Address - Fax:218-284-5944
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN451262084P0800X
ND94802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND23695OtherBCBS
MN187K5S1OtherBCBS
ND23695Medicare ID - Type Unspecified