Provider Demographics
NPI:1073841144
Name:SIMS, STEPHANIE (CST/CSFA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:SIMS
Suffix:
Gender:F
Credentials:CST/CSFA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:FUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CST/CSFA
Mailing Address - Street 1:3812 S BERMUDA AVE
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-2880
Mailing Address - Country:US
Mailing Address - Phone:918-619-5976
Mailing Address - Fax:
Practice Address - Street 1:3812 S BERMUDA AVE
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063
Practice Address - Country:US
Practice Address - Phone:918-619-5976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant