Provider Demographics
NPI:1295379196
Name:SIMS, MARY AMANDA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:AMANDA
Last Name:SIMS
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 1:229 EMPRESS ALEXANDRA PL
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-4092
Mailing Address - Country:US
Mailing Address - Phone:540-356-0567
Mailing Address - Fax:
Practice Address - Street 1:229 EMPRESS ALEXANDRA PL
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-4092
Practice Address - Country:US
Practice Address - Phone:540-356-0567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002076034163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse