Provider Demographics
NPI:1124784939
Name:HARRIDGE, NICOLETTE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:
Last Name:HARRIDGE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S GIBSON RD APT 3312
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-2670
Mailing Address - Country:US
Mailing Address - Phone:702-626-3580
Mailing Address - Fax:
Practice Address - Street 1:1050 W GALLERIA DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-4800
Practice Address - Country:US
Practice Address - Phone:702-963-7451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN35157163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant