Provider Demographics
NPI:1801692918
Name:SIMON, ANGIE GAY
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:GAY
Last Name:SIMON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 GALVIN RD N
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-4899
Mailing Address - Country:US
Mailing Address - Phone:531-232-5040
Mailing Address - Fax:
Practice Address - Street 1:4128 N 38TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-2210
Practice Address - Country:US
Practice Address - Phone:531-242-3264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist