Healthcare Provider Details

I. General information

NPI: 1336758812
Provider Name (Legal Business Name): JUSTINE SIMS APN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WESTPORT CT
BLOOMINGTON IL
61704-8233
US

IV. Provider business mailing address

6 WESTPORT CT
BLOOMINGTON IL
61704-8233
US

V. Phone/Fax

Practice location:
  • Phone: 309-722-4020
  • Fax: 309-740-4440
Mailing address:
  • Phone: 309-722-4020
  • Fax: 309-740-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209.021728
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: