Individual
ANTHONY SIMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
600 EAST BLVD, ELKHART, IN 46514
(574) 524-8130
Mailing address
3245 HEALTH DRIVE, SUITE 100, GRANGER, IN 46530
(574) 647-1840
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28250920A
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
28250920A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300078303
—
IN
Enumeration date
02/16/2023
Last updated
08/21/2023
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