Provider Demographics
NPI:1902535107
Name:SIMONS, STEFANIE (AGNP)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:SIMONS
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12380 S 1450 W
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7071
Mailing Address - Country:US
Mailing Address - Phone:801-879-9104
Mailing Address - Fax:
Practice Address - Street 1:1878 W 12600 S STE 336
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7026
Practice Address - Country:US
Practice Address - Phone:801-879-9104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7960610-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner