Individual
MARY L SIMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
1746
WI
363LF0000X
Family Nurse Practitioner
Primary
1746
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43926800
—
WI
Enumeration date
06/14/2005
Last updated
12/29/2017
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