Provider Demographics
NPI:1477693166
Name:SIMS, CONNIE ELAINE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:ELAINE
Last Name:SIMS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5543 SUNRISE VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9393
Mailing Address - Country:US
Mailing Address - Phone:513-777-9728
Mailing Address - Fax:513-603-6241
Practice Address - Street 1:9050 CENTRE POINTE DR STE 400
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4875
Practice Address - Country:US
Practice Address - Phone:513-603-6762
Practice Address - Fax:513-603-6241
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP 07949363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHNP1732Medicare ID - Type Unspecified
NHS6437Medicare UPIN