Nicole Sadorra

Key facts

NPI

1265267751

Entity type

Individual (NPI type 1)

Primary specialty

Lactation Consultant (Registered Nurse) 163WL0100X

License

R258477 (MD)

Practice address

2417 Chilham PL
Potomac, MD 20854-6214

Phone

(410) 978-3269

NPI assigned

Sep 4, 2024

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 4, 2024.

{
    "created_epoch": "1725408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1265267751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2417 CHILHAM PL",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "208546214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2417 CHILHAM PL",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "208546214",
            "telephone_number": "410-978-3269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SADORRA",
        "first_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-04",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "MD",
            "license": "R258477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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