Individual provider Active NPI

Andrea Sue Simon, RN

  • Cardiac Rehabilitation Registered Nurse
  • Albert Lea, MN
National Provider Identifier
1043722101
Registry record updated Oct 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiac Rehabilitation Registered NurseTaxonomy code 163WC3500X
License
R1697221 Issued in MN
Practice address
404 W Fountain St
Albert Lea, MN 56007-2437
Phone
(507) 668-2162
Fax
(507) 668-2165
NPI assigned
Oct 30, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiac Rehabilitation Registered Nurse 163WC3500X R1697221 MN Primary

Addresses

Primary practice location

404 W Fountain St
Albert Lea, MN 56007-2437

Mailing address

404 W Fountain St
Albert Lea, MN 56007-2437
Phone (507) 668-2162

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
R1697221MNMDCardiac Rehabilitation Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509321600000",
    "number": "1043722101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 W FOUNTAIN ST",
            "city": "ALBERT LEA",
            "state": "MN",
            "postal_code": "560072437",
            "telephone_number": "507-668-2162",
            "fax_number": "507-668-2165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 W FOUNTAIN ST",
            "city": "ALBERT LEA",
            "state": "MN",
            "postal_code": "560072437",
            "telephone_number": "507-668-2162",
            "fax_number": "507-668-2165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "ANDREA",
        "middle_name": "SUE",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-30",
        "last_updated": "2017-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC3500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Cardiac Rehabilitation",
            "state": "MN",
            "license": "R1697221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albert Lea, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.