Provider Demographics
NPI:1730664319
Name:SAWYERS, NICOLE (CLD)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:SAWYERS
Suffix:
Gender:F
Credentials:CLD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:SAWYERS TODD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CLD
Mailing Address - Street 1:4211 SHELMIRE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-3618
Mailing Address - Country:US
Mailing Address - Phone:267-777-0815
Mailing Address - Fax:
Practice Address - Street 1:4211 SHELMIRE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-3618
Practice Address - Country:US
Practice Address - Phone:267-777-0815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula