Provider Demographics
NPI:1538354501
Name:SIMON, JAMIE ANN (PA-C)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:ANN
Last Name:SIMON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:ANN
Other - Last Name:SEBALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3875 BAY RD
Mailing Address - Street 2:SUITE 1-S
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2417
Mailing Address - Country:US
Mailing Address - Phone:989-892-5664
Mailing Address - Fax:989-892-0662
Practice Address - Street 1:3875 BAY RD
Practice Address - Street 2:SUITE 1-S
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2417
Practice Address - Country:US
Practice Address - Phone:989-892-5664
Practice Address - Fax:989-892-0662
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005128363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant