Individual
MS. SHOSHANA SUSAN SIMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, RN, CS
Contact information
Practice address
1100 LOGGER CT, SUITE 100G, RALEIGH, NC 27609-8525
(919) 855-9090
(919) 786-9154
Mailing address
1100 LOGGER COURT, SUITE 100G, RALEIGH, NC 27609-8512
(919) 855-9090
(919) 786-9154
Taxonomy
Speciality
Code
Description
License number
State
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
099925
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
76654
BLUECROSS BLUE SHIELD ID
NC
01
—
RA792
EMPIRE BLUE CROSS BLUE SH
NC
Enumeration date
04/09/2007
Last updated
12/05/2014
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