Provider Demographics
NPI:1619747599
Name:NIEDRICH, NICOLE KAY (RN BSN IBCLC)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:KAY
Last Name:NIEDRICH
Suffix:
Gender:F
Credentials:RN BSN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 MILITARY CUTOFF RD APT 130
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5724
Mailing Address - Country:US
Mailing Address - Phone:919-664-4241
Mailing Address - Fax:
Practice Address - Street 1:1507 MILITARY CUTOFF RD APT 130
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5724
Practice Address - Country:US
Practice Address - Phone:919-664-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL-312382163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant