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General NPI Number Information
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NPI Number | 1992692214
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Entity Type | Individual
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Provider Name | LOLA DOMINIQUE SIMS
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Gender | Female
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Dates
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Enumeration Date | 06/19/2025
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 1019 E 76TH ST
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City | CLEVELAND
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State | OH
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Zip | 44103-2001
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Country | US
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Telephone | 216-309-6839
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Fax |
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Provider Business Mailing Address
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Address Line | 18009 LAKE SHORE BLVD APT 305
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City | CLEVELAND
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State | OH
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Zip | 44119-1244
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Country | US
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Telephone | 216-309-6839
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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 | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 602567440723
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License Number State | OH
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