Provider Demographics
NPI:1386237287
Name:JONES, NICOLE I (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:I
Last Name:JONES
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 1:12104 S 181ST DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-7865
Mailing Address - Country:US
Mailing Address - Phone:623-238-4330
Mailing Address - Fax:
Practice Address - Street 1:12104 S 181ST DR
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-7865
Practice Address - Country:US
Practice Address - Phone:623-238-4330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN144570163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant