Provider Demographics
NPI:1972934388
Name:FOULKS-THOMAS, SABRINA MICHELLE (RN, CPM, LM, IBCLC)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:MICHELLE
Last Name:FOULKS-THOMAS
Suffix:
Gender:
Credentials:RN, CPM, LM, IBCLC
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:MICHELLE
Other - Last Name:FOULKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CPM, LM, IBCLC
Mailing Address - Street 1:W233N7735 CHESTNUT CT
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-1522
Mailing Address - Country:US
Mailing Address - Phone:612-237-2746
Mailing Address - Fax:262-500-4474
Practice Address - Street 1:N63W23217 MAIN ST UNIT 201
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-3204
Practice Address - Country:US
Practice Address - Phone:612-237-2746
Practice Address - Fax:262-500-4474
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11147732163WL0100X
WI155-49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwife
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1972934388Medicaid