=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225509763
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RASHAWN ALISIA SIMS PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2018
-----------------------------------------------------
Last Update Date | 12/10/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2875 W 19TH ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60623-3501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-484-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 307 S EVERGREEN AVE
-----------------------------------------------------
City | WOODBURY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08096-2739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 185-668-6430
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 085.006781
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------