Provider Demographics
NPI:1497037006
Name:SIMS, EDIE L (LMT)
Entity Type:Individual
Prefix:MS
First Name:EDIE
Middle Name:L
Last Name:SIMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1174 W 1850 S
Mailing Address - Street 2:
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84087-2322
Mailing Address - Country:US
Mailing Address - Phone:801-597-3019
Mailing Address - Fax:
Practice Address - Street 1:457 E 3300 S
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84115-4112
Practice Address - Country:US
Practice Address - Phone:801-597-3019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3806054701174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist