1972934388 NPI number — SABRINA MICHELLE FOULKS-THOMAS RN, CPM, LM, IBCLC

Table of content: SABRINA MICHELLE FOULKS-THOMAS RN, CPM, LM, IBCLC (NPI 1972934388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972934388 NPI number — SABRINA MICHELLE FOULKS-THOMAS RN, CPM, LM, IBCLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOULKS-THOMAS
Provider First Name:
SABRINA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, CPM, LM, IBCLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FOULKS
Provider Other First Name:
SABRINA
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, CPM, LM, IBCLC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972934388
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
W233N7735 CHESTNUT CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUSSEX
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53089-1522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-237-2746
Provider Business Mailing Address Fax Number:
262-500-4474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
N63W23217 MAIN ST UNIT 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUSSEX
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53089-3204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-237-2746
Provider Business Practice Location Address Fax Number:
262-500-4474
Provider Enumeration Date:
12/10/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WL0100X , with the licence number:  11147732 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 176B00000X , with the licence number: 155-49 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1972934388 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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