Provider Demographics
NPI:1083921910
Name:SIMMS, SHERIDETH ANN (RN)
Entity Type:Individual
Prefix:MISS
First Name:SHERIDETH
Middle Name:ANN
Last Name:SIMMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2983 MARSHA LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-4217
Mailing Address - Country:US
Mailing Address - Phone:937-251-5373
Mailing Address - Fax:
Practice Address - Street 1:2983 MARSHA LN
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-4217
Practice Address - Country:US
Practice Address - Phone:937-251-5373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.140193164W00000X
OH387720163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse