Healthcare Provider Details

I. General information

NPI: 1235011347
Provider Name (Legal Business Name): STANISHA NE'KEYLA SIMS-MONIE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 HOLLYWREATH CT
DAYTON OH
45424-4640
US

IV. Provider business mailing address

4840 HOLLYWREATH CT
DAYTON OH
45424-4640
US

V. Phone/Fax

Practice location:
  • Phone: 937-260-2550
  • Fax:
Mailing address:
  • Phone: 937-260-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number457343
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number457343
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number457343
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number457343
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: