Provider Demographics
NPI:1770115966
Name:SIMON, BREEANNA BAKER (PA)
Entity type:Individual
Prefix:
First Name:BREEANNA
Middle Name:BAKER
Last Name:SIMON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BREEANNA
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:866 SEVEN HILLS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4376
Mailing Address - Country:US
Mailing Address - Phone:702-430-5333
Mailing Address - Fax:702-430-5335
Practice Address - Street 1:866 SEVEN HILLS DR STE 201
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4376
Practice Address - Country:US
Practice Address - Phone:702-430-5333
Practice Address - Fax:702-430-5335
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2188363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant