Provider Demographics
NPI:1780658336
Name:JOE, ETHER SIMS (FNP)
Entity Type:Individual
Prefix:MS
First Name:ETHER
Middle Name:SIMS
Last Name:JOE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:51 ROBINHOOD CIR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4260
Mailing Address - Country:US
Mailing Address - Phone:336-922-6840
Mailing Address - Fax:
Practice Address - Street 1:W. S. S. U., A. H. RAY STUDENT HEALTH CENTER
Practice Address - Street 2:601 MARTIN LUTHER KING, JR., DR.
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27110-0001
Practice Address - Country:US
Practice Address - Phone:336-750-3302
Practice Address - Fax:336-750-3303
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMB200809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000169Medicaid
NC7000169Medicaid
NC259-4534Medicare ID - Type Unspecified