Provider Demographics
NPI:1194120469
Name:GOUGH, SHARON ANN (IBCLC, RLC)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ANN
Last Name:GOUGH
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10727 PARKGATE DR
Mailing Address - Street 2:
Mailing Address - City:NOKESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20181-2921
Mailing Address - Country:US
Mailing Address - Phone:703-927-4406
Mailing Address - Fax:
Practice Address - Street 1:10727 PARKGATE DR
Practice Address - Street 2:
Practice Address - City:NOKESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20181-2921
Practice Address - Country:US
Practice Address - Phone:703-927-4406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAL-17076174N00000X
VA19210911174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN