Provider Demographics
NPI:1902392764
Name:BEACH-SIMS, CONNIE FRANCIS
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:FRANCIS
Last Name:BEACH-SIMS
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 1:5087 OTTAWA PARK PL
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-5185
Mailing Address - Country:US
Mailing Address - Phone:703-628-8868
Mailing Address - Fax:
Practice Address - Street 1:896 SOUTHERN AVE SE APT 106
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3453
Practice Address - Country:US
Practice Address - Phone:202-373-5299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant