Provider Demographics
NPI:1407348337
Name:SIMS, BRENDA NESHELL (FNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:NESHELL
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 1:741 S MCHENRY AVE STE C-D
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7445
Mailing Address - Country:US
Mailing Address - Phone:815-455-1266
Mailing Address - Fax:
Practice Address - Street 1:741 S MCHENRY AVE STE C-D
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7445
Practice Address - Country:US
Practice Address - Phone:815-455-1266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.017659363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner