Provider Demographics
NPI:1841523826
Name:SIMS, DOMINIQUE D
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:D
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 1:1164 KAMPENGA AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5215
Mailing Address - Country:US
Mailing Address - Phone:231-343-6195
Mailing Address - Fax:
Practice Address - Street 1:1164 KAMPENGA AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5215
Practice Address - Country:US
Practice Address - Phone:231-343-6195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide