Provider Demographics
NPI:1427879030
Name:MCNICHOLAS, SARAH (RN, BSN, IBCLC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MCNICHOLAS
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:WETZEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, BSN, IBCLC
Mailing Address - Street 1:5780 BILLET ST APT 207
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-7051
Mailing Address - Country:US
Mailing Address - Phone:240-415-8757
Mailing Address - Fax:
Practice Address - Street 1:99 ASHLEY CT
Practice Address - Street 2:
Practice Address - City:MYERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21773-8417
Practice Address - Country:US
Practice Address - Phone:240-205-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL-24176163WL0100X
MDR183634163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant