Provider Demographics
NPI:1770606147
Name:SIMON, SHOSHANA SUSAN (MSN, RN, CS)
Entity type:Individual
Prefix:MS
First Name:SHOSHANA
Middle Name:SUSAN
Last Name:SIMON
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Gender:F
Credentials:MSN, RN, CS
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Mailing Address - Street 1:1100 LOGGER COURT
Mailing Address - Street 2:SUITE 100G
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8512
Mailing Address - Country:US
Mailing Address - Phone:919-855-9090
Mailing Address - Fax:919-786-9154
Practice Address - Street 1:1100 LOGGER CT
Practice Address - Street 2:SUITE 100G
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-8525
Practice Address - Country:US
Practice Address - Phone:919-855-9090
Practice Address - Fax:919-786-9154
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2014-12-05
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Provider Licenses
StateLicense IDTaxonomies
NC099925364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC76654OtherBLUECROSS BLUE SHIELD ID
NCRA792OtherEMPIRE BLUE CROSS BLUE SH