Provider Demographics
NPI:1679110894
Name:SIM, ELIZABETH AMBER (RN)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:AMBER
Last Name:SIM
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 1:272 E SAGEBRUSH ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4934
Mailing Address - Country:US
Mailing Address - Phone:623-535-6098
Mailing Address - Fax:
Practice Address - Street 1:20873 W SUNRISE LN
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-7593
Practice Address - Country:US
Practice Address - Phone:623-547-1618
Practice Address - Fax:623-853-2314
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN199796163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool