Provider Demographics
NPI:1578268132
Name:SIMMS - MERRIMAN, MICHELLE ANDREA
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANDREA
Last Name:SIMMS - MERRIMAN
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 1:20417 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6321
Mailing Address - Country:US
Mailing Address - Phone:216-543-1580
Mailing Address - Fax:
Practice Address - Street 1:20417 KINGS HWY
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-6321
Practice Address - Country:US
Practice Address - Phone:216-543-1580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
305S00000X, 385H00000X, 343900000X, 374U00000X, 253Z00000X
FL374U00000X
FL20610402374U00000X, 246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes385H00000XRespite Care FacilityRespite Care
No305S00000XManaged Care OrganizationsPoint of Service
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No253Z00000XAgenciesIn Home Supportive Care