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General NPI Number Information
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NPI Number | 1780658336
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Entity Type | Individual
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Provider Name | ETHER SIMS JOE FNP
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Gender | Female
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Dates
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Enumeration Date | 02/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | W. S. S. U., A. H. RAY STUDENT HEALTH CENTER 601 MARTIN LUTHER KING, JR., DR.
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City | WINSTON-SALEM
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State | NC
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Zip | 27110-0001
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Country | US
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Telephone | 336-750-3302
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Fax | 336-750-3303
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Provider Business Mailing Address
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Address Line | 51 ROBINHOOD CIR
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City | WINSTON SALEM
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State | NC
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Zip | 27106-4260
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Country | US
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Telephone | 336-922-6840
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | MB200809
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License Number State | NC
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