Provider Demographics
NPI:1124838578
Name:SIMS, MARISSA
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
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 1:1606 ALASKA CIR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2161
Mailing Address - Country:US
Mailing Address - Phone:402-984-6978
Mailing Address - Fax:
Practice Address - Street 1:1606 ALASKA CIR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2161
Practice Address - Country:US
Practice Address - Phone:402-984-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor