Provider Demographics
NPI:1528880820
Name:WHITEHEAD, SHARI J (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:J
Last Name:WHITEHEAD
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 1:1601 LANCELOT CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-2849
Mailing Address - Country:US
Mailing Address - Phone:425-876-8426
Mailing Address - Fax:
Practice Address - Street 1:1601 LANCELOT CIR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-2849
Practice Address - Country:US
Practice Address - Phone:425-876-8426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX535468163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant