Provider Demographics
NPI:1528808029
Name:NOLAN-SIMS, STEPHANIE YVETTE (LPN)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:YVETTE
Last Name:NOLAN-SIMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 TYLER TRCE
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-8786
Mailing Address - Country:US
Mailing Address - Phone:678-608-7369
Mailing Address - Fax:
Practice Address - Street 1:201 TYLER TRCE
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-8786
Practice Address - Country:US
Practice Address - Phone:678-608-7369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN080500164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse