Provider Demographics
NPI:1811240260
Name:SIMS, FERN CANISHA (LPN)
Entity Type:Individual
Prefix:MS
First Name:FERN
Middle Name:CANISHA
Last Name:SIMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30056 EUCLID AVE UNIT 5
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-1664
Mailing Address - Country:US
Mailing Address - Phone:216-392-3136
Mailing Address - Fax:
Practice Address - Street 1:30056 EUCLID AVE UNIT 5
Practice Address - Street 2:
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-1664
Practice Address - Country:US
Practice Address - Phone:216-392-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN147129MIV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse