Provider Demographics
NPI:1043035678
Name:MIMS, SHEILA JEAN
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:JEAN
Last Name:MIMS
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 1:4100 QUENTIN BLVD APT 210
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-8528
Mailing Address - Country:US
Mailing Address - Phone:614-809-0988
Mailing Address - Fax:
Practice Address - Street 1:4100 QUENTIN BLVD APT 210
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-8528
Practice Address - Country:US
Practice Address - Phone:614-809-0988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant