Healthcare Provider Details

I. General information

NPI: 1164897880
Provider Name (Legal Business Name): JANET SIMS BSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8291 FREDERICK ST
SALEM MI
48175
US

IV. Provider business mailing address

8291 FREDERICK ST
SALEM MI
48175
US

V. Phone/Fax

Practice location:
  • Phone: 972-834-8325
  • Fax:
Mailing address:
  • Phone: 972-834-8325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number4704178178
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: