Provider Demographics
NPI:1992692214
Name:SIMS, LOLA DOMINIQUE
Entity type:Individual
Prefix:
First Name:LOLA
Middle Name:DOMINIQUE
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 1:18009 LAKE SHORE BLVD APT 305
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1244
Mailing Address - Country:US
Mailing Address - Phone:216-309-6839
Mailing Address - Fax:
Practice Address - Street 1:1019 E 76TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-2001
Practice Address - Country:US
Practice Address - Phone:216-309-6839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6025674407233747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant