Provider Demographics
NPI:1366033698
Name:SIMS, RACHELLE LAVONNE (RN)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:LAVONNE
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 1:5609 FOXCROSS CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-2801
Mailing Address - Country:US
Mailing Address - Phone:765-720-3233
Mailing Address - Fax:
Practice Address - Street 1:5609 FOXCROSS CT
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-2801
Practice Address - Country:US
Practice Address - Phone:765-720-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28161446A163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine