Provider Demographics
NPI:1891517165
Name:SIMS, JOSHUA EVAN
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:EVAN
Last Name:SIMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W UTOPIA AVE UNIT 513
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-2384
Mailing Address - Country:US
Mailing Address - Phone:309-507-3364
Mailing Address - Fax:
Practice Address - Street 1:3690 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84115-4423
Practice Address - Country:US
Practice Address - Phone:801-587-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program