Individual
MICHAEL MIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3710 SW US VETERANS HOSPITAL RD, PORTLAND, OR 97239-2964
(360) 759-1901
Mailing address
7466 GRANT VILLAGE DR APT C, SAINT LOUIS, MO 63123-1431
(662) 582-0579
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
887609
MS
Other
Enumeration date
08/21/2023
Last updated
08/21/2023
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