Provider Demographics
NPI:1578106217
Name:EMOKPAIRE, SIMONPETER O (NP)
Entity type:Individual
Prefix:
First Name:SIMONPETER
Middle Name:O
Last Name:EMOKPAIRE
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 MARKET ST NE STE 510
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1807
Mailing Address - Country:US
Mailing Address - Phone:971-439-0234
Mailing Address - Fax:832-321-2981
Practice Address - Street 1:3000 MARKET ST NE STE 510
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1807
Practice Address - Country:US
Practice Address - Phone:971-439-0234
Practice Address - Fax:832-321-2981
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35266363LP0808X
TXAP144841363LP0808X
OR202209114RN363LP0808X
TX840583363LP0808X
OR202209315NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR202209315NP-PPOtherLICENSE
OR202209114RNOtherRN LICENSE