Provider Demographics
NPI:1447965330
Name:SIMPSON, CORY SHANNON (REGISTERED NURSE/ RN)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:SHANNON
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:REGISTERED NURSE/ RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 RIM VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-8270
Mailing Address - Country:US
Mailing Address - Phone:928-706-3556
Mailing Address - Fax:
Practice Address - Street 1:1115 RIM VIEW DR
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-8270
Practice Address - Country:US
Practice Address - Phone:928-706-3556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN158505163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty