Provider Demographics
NPI:1740234103
Name:MCNICHOLS, SHARON (LAC)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:MCNICHOLS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4670 SW WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-0530
Mailing Address - Country:US
Mailing Address - Phone:503-646-8575
Mailing Address - Fax:503-526-0783
Practice Address - Street 1:4670 SW WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-0530
Practice Address - Country:US
Practice Address - Phone:503-646-8575
Practice Address - Fax:503-526-0783
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00228171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1720542749OtherGROUP NPI