Individual
LAKEISHA MIMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1727 BRADDOCK DR, SIERRA VISTA, AZ 85635-4493
(520) 226-5347
Mailing address
994 S HARRISON RD, TUCSON, AZ 85748-6608
(520) 721-1887
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
8164517
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8164517
CONTRACTOR
AZ
Enumeration date
06/13/2017
Last updated
06/13/2017
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