Provider Demographics
NPI:1518575547
Name:SIMS, JESSICA MAEVE (LPN / IC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MAEVE
Last Name:SIMS
Suffix:
Gender:F
Credentials:LPN / IC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85-175 FARRINGTON HWY APT B401
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-2145
Mailing Address - Country:US
Mailing Address - Phone:808-379-5229
Mailing Address - Fax:
Practice Address - Street 1:85-175 FARRINGTON HWY APT B401
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-2145
Practice Address - Country:US
Practice Address - Phone:808-379-5229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI19181164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse