Provider Demographics
NPI:1023358520
Name:NICHOLS, SHARON (RN, IBCLC, RLC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:RN, IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9606 VERMILION RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-5821
Mailing Address - Country:US
Mailing Address - Phone:865-705-9577
Mailing Address - Fax:
Practice Address - Street 1:9606 VERMILION RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-5821
Practice Address - Country:US
Practice Address - Phone:865-705-9577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000059920163W00000X
TN19210976163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse