Provider Demographics
NPI:1417392051
Name:SIMS, SHANWANDA
Entity Type:Individual
Prefix:MS
First Name:SHANWANDA
Middle Name:
Last Name:SIMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:NATALBANY
Mailing Address - State:LA
Mailing Address - Zip Code:70451-0716
Mailing Address - Country:US
Mailing Address - Phone:985-474-9025
Mailing Address - Fax:
Practice Address - Street 1:11236 HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-4146
Practice Address - Country:US
Practice Address - Phone:985-748-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA220394164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse