Provider Demographics
NPI:1235171216
Name:SIMS, SUSAN G (FNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:SIMS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 SW COAST HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-5240
Mailing Address - Country:US
Mailing Address - Phone:541-265-8816
Mailing Address - Fax:
Practice Address - Street 1:1010 SW COAST HWY STE 201
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-5240
Practice Address - Country:US
Practice Address - Phone:541-265-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201701168NP363LF0000X
SC640363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0180Medicaid
SCP00891756OtherRAIL ROAD ID#
SCNP0180Medicaid
SCQ316717522Medicare PIN
SCQ316717126Medicare PIN