Provider Demographics
NPI:1336204973
Name:SIMON, JAMIE W (FNP, APNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:W
Last Name:SIMON
Suffix:
Gender:F
Credentials:FNP, APNP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:WYNN
Other - Last Name:GILBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:262-532-7600
Mailing Address - Fax:262-532-7602
Practice Address - Street 1:N112W17975 MEQUON RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-2425
Practice Address - Country:US
Practice Address - Phone:262-532-7600
Practice Address - Fax:262-532-7602
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2182363L00000X
WI2182033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36022600Medicaid
WI1336204973Medicaid
WI0008466095Medicare ID - Type Unspecified