Provider Demographics
NPI:1922470327
Name:SIMON, MIA SHARON (LPN)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:SHARON
Last Name:SIMON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 MENLO RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-5053
Mailing Address - Country:US
Mailing Address - Phone:216-317-5888
Mailing Address - Fax:
Practice Address - Street 1:3620 MENLO RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-5053
Practice Address - Country:US
Practice Address - Phone:216-317-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-24
Last Update Date:2015-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN151755-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse