Provider Demographics
NPI:1447527213
Name:SIMON-BURRELL, MARCI LAVAUGHN (MSN, RN, WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MARCI
Middle Name:LAVAUGHN
Last Name:SIMON-BURRELL
Suffix:
Gender:F
Credentials:MSN, RN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3980 JOHN R ST
Mailing Address - Street 2:2252
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2018
Mailing Address - Country:US
Mailing Address - Phone:313-966-2488
Mailing Address - Fax:
Practice Address - Street 1:3980 JOHN R ST
Practice Address - Street 2:2252
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2018
Practice Address - Country:US
Practice Address - Phone:313-966-2488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704196032363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health