Provider Demographics
NPI:1437825056
Name:SIMS, MICHELLE TRACEY (RN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:TRACEY
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 1:124 WIGFALL ST
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3509
Mailing Address - Country:US
Mailing Address - Phone:843-934-9886
Mailing Address - Fax:
Practice Address - Street 1:124 WIGFALL ST
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3509
Practice Address - Country:US
Practice Address - Phone:843-934-9886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC230698163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse