Provider Demographics
NPI:1043004922
Name:SIMON, MARIANNE ELISE (PMHNP)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:ELISE
Last Name:SIMON
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:ELISE
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2466 MONTAVISTA PL W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-3723
Mailing Address - Country:US
Mailing Address - Phone:317-252-2222
Mailing Address - Fax:
Practice Address - Street 1:2466 MONTAVISTA PL W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-3723
Practice Address - Country:US
Practice Address - Phone:317-252-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61679964363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health