Basic Information
| Provider Information | |||||||||
| NPI: | 1013687441 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIM | ||||||||
| FirstName: | MIKAELA ANGELA | ||||||||
| MiddleName: | MEJIA | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2121 W 39TH ST APT 17 | ||||||||
| Address2: | |||||||||
| City: | KEARNEY | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688451241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3082709388 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 E 31ST ST | ||||||||
| Address2: | |||||||||
| City: | KEARNEY | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688472908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3088657100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2021 | ||||||||
| LastUpdateDate: | 09/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | 93297 | NE | Y | Nursing Service Providers | Registered Nurse | Critical Care Medicine |
No ID Information.