Basic Information
| Provider Information | |||||||||
| NPI: | 1164997979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMPSON | ||||||||
| FirstName: | RAYMOND | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 122 WYOMING ST | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454092731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372234461 | ||||||||
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| Practice Location | |||||||||
| Address1: | 122 WYOMING ST | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454092731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372234461 | ||||||||
| FaxNumber: | 9374497603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2018 | ||||||||
| LastUpdateDate: | 05/07/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | LE-00025353 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2100X | APRN.CNP.023792 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 163W00000X | RN.342469 | OH | N | Nursing Service Providers | Registered Nurse |
No ID Information.