Provider Demographics
NPI:1245091966
Name:SIMS, DONNA JEAN ERLINE
Entity type:Individual
Prefix:
First Name:DONNA JEAN
Middle Name:ERLINE
Last Name: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 1:806 PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44502-2533
Mailing Address - Country:US
Mailing Address - Phone:330-398-5471
Mailing Address - Fax:
Practice Address - Street 1:806 PALMER AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-2533
Practice Address - Country:US
Practice Address - Phone:330-398-5471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN581494163WG0000X
OHRN287044163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice