Provider Demographics
NPI:1053142257
Name:SIMPSON, SHACORA (RN)
Entity type:Individual
Prefix:MRS
First Name:SHACORA
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 W MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-6706
Mailing Address - Country:US
Mailing Address - Phone:602-329-3458
Mailing Address - Fax:
Practice Address - Street 1:3302 W LOUISE DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-1688
Practice Address - Country:US
Practice Address - Phone:623-445-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208316163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse