Individual
MS. FAITH SUSAN SIMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
45081 LITTLE LAKE STREET, MENDOCINO, CA 95460
(707) 937-1055
(707) 937-1061
Mailing address
PO BOX 38, MENDOCINO, CA 95460
(707) 937-1055
(707) 937-1061
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
10815
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427078245
—
CA
01
—
NPF10815
LICENSE NUMBER
CA
01
—
P00872334
RAILROAD MEDICARE
CA
01
—
RN422135
LICENSE NUMBER
CA
Enumeration date
07/21/2006
Last updated
02/07/2012
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